MEDICARE: DR. ADAM M. BRICKMAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	017174	NY
2	103T00000X	Psychologist	017174	NY

General Provider Information

NPI Number	:	1013109230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM M. BRICKMAN PH.D.

Provider Business Mailing Address
First Line	:	615 FORT WASHINGTON AVE
Second Line	:	#3D
City	:	NEW YORK
State	:	NY
Zip	:	10040-3954
Country	:	US
Telephone Number	:	646-641-0616
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 FORT WASHINGTON AVE
Second Line	:	#3D
City	:	NEW YORK
State	:	NY
Zip	:	10040-3954
Country	:	US
Telephone Number	:	646-641-0616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2007
Last Update Date	:	08/11/2007

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