MEDICARE: DR. PETER G. MEDONIS JR. ED.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	103TC1900X	Counseling Psychologist	012009	NY

General Provider Information

NPI Number	:	1366491300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER G. MEDONIS JR. ED.D.

Provider Business Mailing Address
First Line	:	2094 ALBANY POST RD
Second Line	:	ROUTE 9A
City	:	MONTROSE
State	:	NY
Zip	:	10548-1454
Country	:	US
Telephone Number	:	914-737-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2094 ALBANY POST RD
Second Line	:	ROUTE 9A
City	:	MONTROSE
State	:	NY
Zip	:	10548-1454
Country	:	US
Telephone Number	:	914-737-4400
Fax Number	:

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	01/25/2026

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