MEDICARE: JOERG BOSE M.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	2084P0800X	Psychiatry Physician	14 80 81	NY

General Provider Information

NPI Number	:	1457494098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOERG BOSE M.D.

Provider Business Mailing Address
First Line	:	20 W 74TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-2401
Country	:	US
Telephone Number	:	212-787-9041
Fax Number	:	212-362-6967

Provider Business Practice Location Address
First Line	:	20 W 74TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-2401
Country	:	US
Telephone Number	:	212-787-9041
Fax Number	:	212-662-6967

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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