MEDICARE: DR. ROBERT UDEWITZ 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	103TB0200X	Cognitive & Behavioral Psychologist	012108-1	NY
2	103TC0700X	Clinical Psychologist	012108-1	NY

General Provider Information

NPI Number	:	1356634448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT UDEWITZ PH.D.

Provider Business Mailing Address
First Line	:	501 5TH AVE RM 1709
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-6129
Country	:	US
Telephone Number	:	646-522-7795
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 5TH AVE RM 1709
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-6129
Country	:	US
Telephone Number	:	646-522-7795
Fax Number	:

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

Provider Enumeration Date	:	05/23/2011
Last Update Date	:	05/23/2011

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