MEDICARE: ROGER D KRAMER 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	103TC0700X	Clinical Psychologist	010856-1	NY

General Provider Information

NPI Number	:	1043408982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER D KRAMER PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 1143
Second Line	:
City	:	SETAUKET
State	:	NY
Zip	:	11733-0813
Country	:	US
Telephone Number	:	516-848-8884
Fax Number	:

Provider Business Practice Location Address
First Line	:	286 SILLS RD
Second Line	:
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-8810
Country	:	US
Telephone Number	:	516-848-8884
Fax Number	:

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	10/04/2007

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