Provider Demographics
NPI:1750480521
Name:KOODEN, HAROLD DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:DAVID
Last Name:KOODEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W 90TH ST
Mailing Address - Street 2:#4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1625
Mailing Address - Country:US
Mailing Address - Phone:212-579-4650
Mailing Address - Fax:212-579-4650
Practice Address - Street 1:306 W 90TH ST
Practice Address - Street 2:#4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1625
Practice Address - Country:US
Practice Address - Phone:212-579-4650
Practice Address - Fax:212-579-4650
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004455-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL 6181Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER