MEDICARE: DR. BERNARD WEITZMAN 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	003344	NY

General Provider Information

NPI Number	:	1548360639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNARD WEITZMAN PH.D.

Provider Business Mailing Address
First Line	:	685 W END AVE
Second Line	:	12D
City	:	NEW YORK
State	:	NY
Zip	:	10025-6819
Country	:	US
Telephone Number	:	212-222-8384
Fax Number	:

Provider Business Practice Location Address
First Line	:	685 W END AVE
Second Line	:	12D
City	:	NEW YORK
State	:	NY
Zip	:	10025-6819
Country	:	US
Telephone Number	:	212-222-8384
Fax Number	:

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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