Healthcare Provider Details

I. General information

NPI: 1285757617
Provider Name (Legal Business Name): BRUCE STEPHEN BAUMGARTEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 BERRY HILL RD
SYOSSET NY
11791-2623
US

IV. Provider business mailing address

114 KATHLEEN DR
SYOSSET NY
11791-5816
US

V. Phone/Fax

Practice location:
  • Phone: 516-733-0368
  • Fax: 516-496-9885
Mailing address:
  • Phone: 516-496-9885
  • Fax: 516-496-9885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number012801
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: