MEDICARE: DR. JOSEPH B ERON PSY.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	103TC0700X	Clinical Psychologist	5938	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6892820	OTHER	NY	GHI
2	132702	OTHER	NY	VALUEOPTIONS

General Provider Information

NPI Number	:	1033223144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH B ERON PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 3901
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12402-3901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 HARBOR CV
Second Line	:
City	:	PIERMONT
State	:	NY
Zip	:	10968-1085
Country	:	US
Telephone Number	:	845-338-5450
Fax Number	:	845-314-8516

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	03/23/2023

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