MEDICARE: CHARLES JOSEPH LATTARULO PHD

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	103T00000X	Psychologist	016566	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033232731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES JOSEPH LATTARULO PHD

Provider Business Mailing Address
First Line	:	160 BROADWAY
Second Line	:	SUITE 900 EAST
City	:	NEW YORK
State	:	NY
Zip	:	10038
Country	:	US
Telephone Number	:	212-726-1585
Fax Number	:	914-437-7913

Provider Business Practice Location Address
First Line	:	160 BROADWAY
Second Line	:	SUITE 900 EAST
City	:	NEW YORK
State	:	NY
Zip	:	10038
Country	:	US
Telephone Number	:	212-726-1585
Fax Number	:	914-437-7913

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	10/16/2017

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