MEDICARE: GINA MARIE KANCSO

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	235Z00000X	Speech-Language Pathologist	021245	NY

General Provider Information

NPI Number	:	1114347135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MARIE KANCSO

Provider Business Mailing Address
First Line	:	1576 E 37TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3418
Country	:	US
Telephone Number	:	718-338-0230
Fax Number	:	718-677-6798

Provider Business Practice Location Address
First Line	:	1576 E 37TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3418
Country	:	US
Telephone Number	:	718-338-0230
Fax Number	:	718-677-6798

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

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	04/17/2014

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Directions to “ GINA MARIE KANCSO ” Practice Location

Language	Start Address	Practice Location

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