MEDICARE: KAKOSSIAN MEDICAL WOMAN CARE PC

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	207V00000X	Obstetrics & Gynecology Physician	217115	NY

General Provider Information

NPI Number	:	1265673115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAKOSSIAN MEDICAL WOMAN CARE PC

Provider Business Mailing Address
First Line	:	8008 NARROWS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2831
Country	:	US
Telephone Number	:	718-833-8777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 BRIGHTON BEACH AVE
Second Line	:	1ST.FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5801
Country	:	US
Telephone Number	:	718-833-8777
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	IRENE KAKOSSIAN
Credential	:	M.D.
Telephone Number	:	718-833-8777

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	03/23/2009

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