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General NPI Number Information
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NPI Number | 1003276015
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Entity Type | Organization
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Legal Business Name | JOHN M ROSS PH.D PSYCHOLOGY PC
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 443 E 87TH ST
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City | NEW YORK
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State | NY
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Zip | 10128-6501
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Country | US
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Telephone | 212-289-6553
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Fax |
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Provider Business Mailing Address
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Address Line | 170 EAST END AVENUE 2L
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City | NEW YORK
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State | NY
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Zip | 10128
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Country | US
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Telephone | 917-273-6275
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN MUNDOR ROSS
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Credential | PHD
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Telephone | 917-273-6275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 005123
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License Number State | NY
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