=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558403410
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL A. SCHENKER PHD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 06/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 N HIATUS RD SUITE 101
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33026-3097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-547-3086
-----------------------------------------------------
Fax | 954-827-0711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 402 NW 152ND LN
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33028-1844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-547-3086
-----------------------------------------------------
Fax | 954-827-0711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL A SCHENKER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 954-547-3086
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY5906
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------