MEDICARE: DR. BIJAN RABENOU 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	103T00000X	Psychologist	007089-1	NY

General Provider Information

NPI Number	:	1194758466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BIJAN RABENOU PH. D.

Provider Business Mailing Address
First Line	:	8421 122ND ST
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-3233
Country	:	US
Telephone Number	:	347-651-5130
Fax Number	:	718-847-3808

Provider Business Practice Location Address
First Line	:	50 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4859
Country	:	US
Telephone Number	:	718-855-7707
Fax Number	:	718-855-7717

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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