MEDICARE: DR. ALAN WINDER 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	016131	NY

General Provider Information

NPI Number	:	1891800355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN WINDER PHD

Provider Business Mailing Address
First Line	:	2407 MOTT AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-1709
Country	:	US
Telephone Number	:	917-751-7254
Fax Number	:	866-575-1763

Provider Business Practice Location Address
First Line	:	2938 BAYSWATER AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-1730
Country	:	US
Telephone Number	:	917-751-7254
Fax Number	:	866-575-1763

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/04/2010

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