MEDICARE: DR. SHIRA KAUFMAN DANZIG 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	103TC0700X	Clinical Psychologist	019089	NY

General Provider Information

NPI Number	:	1801181565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRA KAUFMAN DANZIG PH.D.

Provider Business Mailing Address
First Line	:	30 W 70TH ST
Second Line	:	SUITE 1A
City	:	NEW YORK
State	:	NY
Zip	:	10023-4636
Country	:	US
Telephone Number	:	917-318-4001
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 W 70TH ST
Second Line	:	SUITE 1A
City	:	NEW YORK
State	:	NY
Zip	:	10023-4636
Country	:	US
Telephone Number	:	917-318-4001
Fax Number	:

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

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	06/21/2016

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