MEDICARE: DIANA HOFMAN-AYNGORN

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	0148831	NY

General Provider Information

NPI Number	:	1215330196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA HOFMAN-AYNGORN

Provider Business Mailing Address
First Line	:	2117 EAST 73RD STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2117 E 73RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6201
Country	:	US
Telephone Number	:	917-501-6286
Fax Number	:

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

Provider Enumeration Date	:	10/06/2014
Last Update Date	:	10/06/2014

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Directions to “ DIANA HOFMAN-AYNGORN ” Practice Location

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