Doctor Name: | DR. MARTIN GEORGE VIGDOR |
NPI Number: | 1326127796 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 004120-1 |
Business Practice Address: | 388 Hardscrabble Rd North Salem, NY - 105601020 |
Business Phone Number: | 9146695526 |
Business Fax Number: | 9146696051 |
Mailing Address: | 388 Hardscrabble Road, NORTH SALEM |
State: | NY |
Postal Code: | 105601020 |
Phone Number: | 9146695526 |
Fax Number: | 9146696051 |
NPI Enumeration Date: | 11/04/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 004120-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |