MEDICARE: DR. GERALD DAVID PHD

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	003986-1	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	:	1609091800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD DAVID PHD

Provider Business Mailing Address
First Line	:	1135 HARRIS AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4816
Country	:	US
Telephone Number	:	917-840-8909
Fax Number	:

Provider Business Practice Location Address
First Line	:	861 E 27TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2803
Country	:	US
Telephone Number	:	917-840-8909
Fax Number	:

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/09/2007

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