MEDICARE: ESEN KARAN 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	103TC0700X	Clinical Psychologist	023909	NY

General Provider Information

NPI Number	:	1033726138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESEN KARAN PHD

Provider Business Mailing Address
First Line	:	674 FIDDLERS BRIDGE RD
Second Line	:
City	:	RHINEBECK
State	:	NY
Zip	:	12572-3278
Country	:	US
Telephone Number	:	917-886-6254
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 W 88TH ST APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-2324
Country	:	US
Telephone Number	:	917-886-6254
Fax Number	:

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

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	09/23/2020

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