MEDICARE: DR. KENNETH C. CONIGLIO PHD

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	102L00000X	Psychoanalyst	000415-1	NY

General Provider Information

NPI Number	:	1952520546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH C. CONIGLIO PHD

Provider Business Mailing Address
First Line	:	115 BELMONT AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3806
Country	:	US
Telephone Number	:	516-297-5024
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 BELMONT AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3806
Country	:	US
Telephone Number	:	516-297-5024
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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