MEDICARE: LAURA JANE DALHEIM MD

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	2084P0800X	Psychiatry Physician	174674	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	174674	OTHER	NY	LICENSE MEDICAL
2	8206	OTHER	RI	LICENSE MEDICAL

General Provider Information

NPI Number	:	1386681641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JANE DALHEIM MD

Provider Business Mailing Address
First Line	:	80 UNIVERSITY PL FL 3C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-4564
Country	:	US
Telephone Number	:	646-526-7398
Fax Number	:	888-610-5424

Provider Business Practice Location Address
First Line	:	80 UNIVERSITY PL FL 3C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-4564
Country	:	US
Telephone Number	:	646-526-7398
Fax Number	:	888-610-5424

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	02/27/2023

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