MEDICARE: BENJAMIN ZVI GRYSMAN 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	103TC0700X	Clinical Psychologist	019732	NY

General Provider Information

NPI Number	:	1841549128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN ZVI GRYSMAN PHD

Provider Business Mailing Address
First Line	:	14108 JEWEL AVE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-1618
Country	:	US
Telephone Number	:	347-815-4228
Fax Number	:	347-402-8186

Provider Business Practice Location Address
First Line	:	14108 JEWEL AVE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-1618
Country	:	US
Telephone Number	:	347-815-4228
Fax Number	:	347-402-8186

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

Provider Enumeration Date	:	09/03/2012
Last Update Date	:	02/02/2015

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