MEDICARE: PSYCHOLOGY YME PC

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

General Provider Information

NPI Number	:	1366765372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOLOGY YME PC

Provider Business Mailing Address
First Line	:	1800 E 18TH ST
Second Line	:	STE A1
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2161
Country	:	US
Telephone Number	:	718-627-0061
Fax Number	:	718-627-0382

Provider Business Practice Location Address
First Line	:	1800 E 18TH ST
Second Line	:	STE A1
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2161
Country	:	US
Telephone Number	:	718-627-0061
Fax Number	:	718-627-0382

Authorized Official
Title or Position	:	OWNER
Name	:	YEVGENIY MARGULIS
Credential	:	PHD
Telephone Number	:	718-627-0061

Provider Enumeration Date	:	03/04/2010
Last Update Date	:	03/04/2010

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