MEDICARE: DR. CHERYL BLUESTONE 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	103T00000X	Psychologist	013684	NY

General Provider Information

NPI Number	:	1659426708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL BLUESTONE PH. D

Provider Business Mailing Address
First Line	:	3755 HENRY HUDSON PKWY APT 11F
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-1539
Country	:	US
Telephone Number	:	718-601-5995
Fax Number	:

Provider Business Practice Location Address
First Line	:	3755 HENRY HUDSON PKWY APT 11F
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-1539
Country	:	US
Telephone Number	:	718-601-5995
Fax Number	:

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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