MEDICARE: DR. WILLIAM J HURST PHD, LP

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	102L00000X	Psychoanalyst	000078	NY

General Provider Information

NPI Number	:	1780891721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM J HURST PHD, LP

Provider Business Mailing Address
First Line	:	149 AMITY ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-6108
Country	:	US
Telephone Number	:	718-858-4664
Fax Number	:	718-858-3633

Provider Business Practice Location Address
First Line	:	149 AMITY ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-6108
Country	:	US
Telephone Number	:	718-858-4664
Fax Number	:	718-858-3633

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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