MEDICARE: STANFORD A GRIFFITH PSYD

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	007974	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811063225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANFORD A GRIFFITH PSYD

Provider Business Mailing Address
First Line	:	8786 188TH ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11423-1131
Country	:	US
Telephone Number	:	718-526-2521
Fax Number	:	718-334-3432

Provider Business Practice Location Address
First Line	:	8786 188TH ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11423-1131
Country	:	US
Telephone Number	:	718-526-2521
Fax Number	:	718-883-6193

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	01/07/2019

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