Healthcare Provider Details

I. General information

NPI: 1043173982
Provider Name (Legal Business Name): KAYLA KOENIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 RT 45 SUITE 203
POMONA NY
10970
US

IV. Provider business mailing address

28 FOREST DR APT F
GARNERVILLE NY
10923-2150
US

V. Phone/Fax

Practice location:
  • Phone: 845-547-9919
  • Fax:
Mailing address:
  • Phone: 646-952-1569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: