MEDICARE: K & K GRAND PARK LLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1609312933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K & K GRAND PARK LLC

Provider Business Mailing Address
First Line	:	110 E 40TH ST
Second Line	:	SUITE 800
City	:	NEW YORK
State	:	NY
Zip	:	10016-1801
Country	:	US
Telephone Number	:	718-833-8777
Fax Number	:	718-656-8400

Provider Business Practice Location Address
First Line	:	8033 SHORE RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2839
Country	:	US
Telephone Number	:	718-833-8777
Fax Number	:	718-646-8400

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LANA LAGANA
Credential	:
Telephone Number	:	718-833-8777

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	01/10/2017

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Directions to “K & K GRAND PARK LLC ” Practice Location

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