MEDICARE: DR. FREDERIC KALENSCHER M.D.,F.A.A.P.

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	2080A0000X	Pediatric Adolescent Medicine Physician	170656-1	NY

General Provider Information

NPI Number	:	1851341127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERIC KALENSCHER M.D.,F.A.A.P.

Provider Business Mailing Address
First Line	:	532 BROADWAY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-5004
Country	:	US
Telephone Number	:	516-798-3090
Fax Number	:	516-798-1195

Provider Business Practice Location Address
First Line	:	532 BROADWAY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-5004
Country	:	US
Telephone Number	:	516-798-3090
Fax Number	:	516-798-1195

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	08/19/2016

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