MEDICARE: NEPONSIT MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	174400000X	Specialist	NY
2	207R00000X	Internal Medicine Physician	NY
3	225100000X	Physical Therapist	NY
4	207Q00000X	Family Medicine Physician	NY

General Provider Information

NPI Number	:	1205164621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEPONSIT MEDICAL PC

Provider Business Mailing Address
First Line	:	714 BEACH 20TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3502
Country	:	US
Telephone Number	:	718-327-7457
Fax Number	:	718-327-7539

Provider Business Practice Location Address
First Line	:	714 BEACH 20TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3502
Country	:	US
Telephone Number	:	718-327-7457
Fax Number	:	718-327-7539

Authorized Official
Title or Position	:	OWNER
Name	:	SHOAHANAH KAHN
Credential	:	MD
Telephone Number	:	718-327-7457

Provider Enumeration Date	:	11/23/2009
Last Update Date	:	10/05/2010

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1639434061 — FAR ROCKAWAY MEDICAL PC
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Directions to “NEPONSIT MEDICAL PC ” Practice Location

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