MEDICARE: DR. MARTIN FRIEDMUTTER 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	009333	NY

General Provider Information

NPI Number	:	1275521866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN FRIEDMUTTER PSY.D.

Provider Business Mailing Address
First Line	:	3635 BELL BLVD STE 203
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-2097
Country	:	US
Telephone Number	:	347-323-5331
Fax Number	:

Provider Business Practice Location Address
First Line	:	3635 BELL BLVD STE 203
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-2097
Country	:	US
Telephone Number	:	347-323-5331
Fax Number	:

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

Provider Enumeration Date	:	10/08/2005
Last Update Date	:	10/06/2016

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