MEDICARE: CHARLES M ZAROFF 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	103G00000X	Clinical Neuropsychologist	015052	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558378935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES M ZAROFF PH.D.

Provider Business Mailing Address
First Line	:	104 E 40TH ST
Second Line	:	STE 607
City	:	NEW YORK
State	:	NY
Zip	:	10016-1801
Country	:	US
Telephone Number	:	212-725-8511
Fax Number	:	212-726-7417

Provider Business Practice Location Address
First Line	:	104 E 40TH ST
Second Line	:	STE 607
City	:	NEW YORK
State	:	NY
Zip	:	10016-1801
Country	:	US
Telephone Number	:	212-725-8511
Fax Number	:	212-726-7417

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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