MEDICARE: DR. CHRISTIAN J. CHURCHILL JR. PH.D., L.P.

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	102L00000X	Psychoanalyst	000856	NY

General Provider Information

NPI Number	:	1386849131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIAN J. CHURCHILL JR. PH.D., L.P.

Provider Business Mailing Address
First Line	:	353 LEXINGTON AVE FL 3
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-0977
Country	:	US
Telephone Number	:	646-316-3224
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 E 41ST ST
Second Line	:	SUITE 3 A
City	:	NEW YORK
State	:	NY
Zip	:	10017-6217
Country	:	US
Telephone Number	:	646-316-3224
Fax Number	:

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	09/08/2020

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