MEDICARE: GEORGE H NORTHRUP 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	103TC0700X	Clinical Psychologist	8994	NY

General Provider Information

NPI Number	:	1497750202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE H NORTHRUP PH.D.

Provider Business Mailing Address
First Line	:	7710 HEWLETT ST
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-1461
Country	:	US
Telephone Number	:	718-343-9300
Fax Number	:	718-347-2982

Provider Business Practice Location Address
First Line	:	7710 HEWLETT ST
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-1461
Country	:	US
Telephone Number	:	718-343-9300
Fax Number	:	718-347-2982

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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Directions to “ GEORGE H NORTHRUP PH.D.” Practice Location

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