MEDICARE: MRS. SANDRA JASCOLKY 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	010583-1	NY

General Provider Information

NPI Number	:	1154446342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA JASCOLKY PH.D.

Provider Business Mailing Address
First Line	:	80 WALL ST
Second Line	:	SUITE 1001
City	:	NEW YORK
State	:	NY
Zip	:	10005-3601
Country	:	US
Telephone Number	:	212-363-5763
Fax Number	:	212-363-1651

Provider Business Practice Location Address
First Line	:	80 WALL ST
Second Line	:	SUITE 1001
City	:	NEW YORK
State	:	NY
Zip	:	10005-3601
Country	:	US
Telephone Number	:	212-363-5763
Fax Number	:	212-363-1651

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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