MEDICARE: MRS. YANA KENIGSBERG NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F402242	NY

General Provider Information

NPI Number	:	1073037925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YANA KENIGSBERG NP

Provider Business Mailing Address
First Line	:	2236 E 66TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6326
Country	:	US
Telephone Number	:	917-495-1736
Fax Number	:

Provider Business Practice Location Address
First Line	:	2236 E 66TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6326
Country	:	US
Telephone Number	:	917-495-1736
Fax Number	:

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

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	07/21/2022

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