MEDICARE: DR. JANET S. WEISBERG-SAMUELS 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	8339-1	NY

General Provider Information

NPI Number	:	1114011038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET S. WEISBERG-SAMUELS PH.D.

Provider Business Mailing Address
First Line	:	160 EAST 89TH STREET
Second Line	:	STE 1B
City	:	NEW YORK
State	:	NY
Zip	:	10128-3231
Country	:	US
Telephone Number	:	212-410-4391
Fax Number	:	212-410-4391

Provider Business Practice Location Address
First Line	:	160 EAST 89TH STREET
Second Line	:	STE 1B
City	:	NEW YORK
State	:	NY
Zip	:	10128-3231
Country	:	US
Telephone Number	:	212-410-4391
Fax Number	:	212-410-4391

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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