MEDICARE: NANCY KAKOZ CNIM

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3273	OTHER		CNIM

General Provider Information

NPI Number	:	1205380409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY KAKOZ CNIM

Provider Business Mailing Address
First Line	:	50 ROSE PL STE 410
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-5311
Country	:	US
Telephone Number	:	888-279-6336
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 BELLE CHASE WAY STE 600
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48911-4274
Country	:	US
Telephone Number	:	888-279-6336
Fax Number	:

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

Provider Enumeration Date	:	08/05/2016
Last Update Date	:	01/27/2026

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