Provider Demographics
NPI:1649397316
Name:WYCKOFF, DAVID WILLARD (DAVID WYCKOFF)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLARD
Last Name:WYCKOFF
Suffix:
Gender:M
Credentials:DAVID WYCKOFF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:344 WEST 36TH STREET
Mailing Address - Street 2:POST GRADUATE CENTER FOR MENTAL HEALTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018
Mailing Address - Country:US
Mailing Address - Phone:212-560-6700
Mailing Address - Fax:212-244-2034
Practice Address - Street 1:344 WEST 36TH STREET
Practice Address - Street 2:POST GRADUATE CENTER FOR MENTAL HEALTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018
Practice Address - Country:US
Practice Address - Phone:212-560-6700
Practice Address - Fax:212-244-2034
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1889922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY435BC1Medicare PIN