MEDICARE: DR. THOMAS E. UNGER 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	006789-1	NY

General Provider Information

NPI Number	:	1194723510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS E. UNGER PH.D.

Provider Business Mailing Address
First Line	:	290 WOODWARD AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14214-1905
Country	:	US
Telephone Number	:	716-833-6084
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 WOODWARD AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14214-1905
Country	:	US
Telephone Number	:	716-833-6084
Fax Number	:

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	07/08/2007

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