MEDICARE: MRS. INNA KREMEN PA

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	363AM0700X	Medical Physician Assistant	013254	NY

General Provider Information

NPI Number	:	1588039846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. INNA KREMEN PA

Provider Business Mailing Address
First Line	:	2829 OCEAN PKWY STE 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7859
Country	:	US
Telephone Number	:	718-743-5300
Fax Number	:	718-743-9540

Provider Business Practice Location Address
First Line	:	2829 OCEAN PKWY STE 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7859
Country	:	US
Telephone Number	:	718-743-5300
Fax Number	:	718-743-9540

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

Provider Enumeration Date	:	12/11/2015
Last Update Date	:	12/11/2015

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