MEDICARE: EILEEN JO BAHL L.P.

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	000057	NY

General Provider Information

NPI Number	:	1801017736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN JO BAHL L.P.

Provider Business Mailing Address
First Line	:	40 KNIGHT LN
Second Line	:
City	:	KINGS PARK
State	:	NY
Zip	:	11754-2020
Country	:	US
Telephone Number	:	631-724-1073
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 IRVING PL
Second Line	:	#LLA
City	:	NEW YORK
State	:	NY
Zip	:	10003-2324
Country	:	US
Telephone Number	:	212-388-1455
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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