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General NPI Number Information
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NPI Number | 1871205922
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Entity Type | Individual
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Provider Name | JEFFREY MOTTER PHD
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Gender | Male
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Dates
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Enumeration Date | 12/20/2022
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 1051 RIVERSIDE DR UNIT 126
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City | NEW YORK
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State | NY
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Zip | 10032-1007
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Country | US
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Telephone | 646-774-8654
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Fax |
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Provider Business Mailing Address
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Address Line | 119 W 72ND ST # 292
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City | NEW YORK
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State | NY
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Zip | 10023-3201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 025432
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 025432
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 025432
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License Number State | NY
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