MEDICARE: MEDECAL CARE KANEVSKY PC

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	207R00000X	Internal Medicine Physician	208006	NY

General Provider Information

NPI Number	:	1063647972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDECAL CARE KANEVSKY PC

Provider Business Mailing Address
First Line	:	1763 E 12TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1013
Country	:	US
Telephone Number	:	718-376-7766
Fax Number	:	718-376-5563

Provider Business Practice Location Address
First Line	:	1763 E 12TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1013
Country	:	US
Telephone Number	:	718-376-7766
Fax Number	:	718-376-5563

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ZHANNA KANEVSKY
Credential	:	MD
Telephone Number	:	718-376-7766

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	06/22/2011

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