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General NPI Number Information
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NPI Number | 1043684681
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Entity Type | Organization
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Legal Business Name | JERRY DUVINSKY PHD LICENSED PSYCHOLOGIST PC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 423 E MAIN ST STE 3
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City | ENDICOTT
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State | NY
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Zip | 13760-6940
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Country | US
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Telephone | 607-754-1101
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Fax | 607-754-1107
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Provider Business Mailing Address
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Address Line | 423 E MAIN ST STE 3
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City | ENDICOTT
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State | NY
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Zip | 13760-6940
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Country | US
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Telephone | 607-754-1101
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Fax | 607-754-1107
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERRY DUVINSKY
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Credential | PH.D.
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Telephone | 607-754-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 010363
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License Number State | NY
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