=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275759268
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELLEN A FARBER PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 EAST 94TH STREET SUITE 1611
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10128-3911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-987-5651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 EAST 94TH STREET SUITE 1611
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10128-3911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-987-5651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 010187
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------