MEDICARE: DR. JUDITH R RABINOR 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	103TP0016X	Prescribing (Medical) Psychologist	7174	NY

General Provider Information

NPI Number	:	1750504635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH R RABINOR PHD

Provider Business Mailing Address
First Line	:	36 BIARRITZ ST
Second Line	:
City	:	LIDO BEACH
State	:	NY
Zip	:	11561-5102
Country	:	US
Telephone Number	:	516-889-3404
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 BIARRITZ ST
Second Line	:
City	:	LIDO BEACH
State	:	NY
Zip	:	11561-5102
Country	:	US
Telephone Number	:	516-889-3404
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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