MEDICARE: PROF. MARVIN MEDOW 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	1744R1102X	Research Study Specialist

General Provider Information

NPI Number	:	1386181055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. MARVIN MEDOW PH.D.

Provider Business Mailing Address
First Line	:	2992 CLEARVIEW ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-2404
Country	:	US
Telephone Number	:	914-602-6299
Fax Number	:	914-593-8890

Provider Business Practice Location Address
First Line	:	2992 CLEARVIEW ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-2404
Country	:	US
Telephone Number	:	914-602-6299
Fax Number	:	914-593-8890

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

Provider Enumeration Date	:	01/19/2017
Last Update Date	:	01/19/2017

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