Provider Demographics
NPI:1194723510
Name:UNGER, THOMAS E (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:UNGER
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 1:290 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1905
Mailing Address - Country:US
Mailing Address - Phone:716-833-6084
Mailing Address - Fax:
Practice Address - Street 1:290 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1905
Practice Address - Country:US
Practice Address - Phone:716-833-6084
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006789-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE81881Medicare ID - Type UnspecifiedMEDICARE ID NUMBER