MEDICARE: DR. MICHELLE ZOHN PSY.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	103T00000X	Psychologist	014770	NY

General Provider Information

NPI Number	:	1194706333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE ZOHN PSY.D.

Provider Business Mailing Address
First Line	:	20925 18TH AVE
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11360-1453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 JESSIE CT
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11363-1925
Country	:	US
Telephone Number	:	718-225-5523
Fax Number	:	718-225-5523

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. MICHELLE ZOHN PSY.D.” Practice Location

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