MEDICARE: RACHEL ANN MCKENNA

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1356699797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL ANN MCKENNA

Provider Business Mailing Address
First Line	:	195 BERKSHIRE DR
Second Line	:
City	:	FARMINGVILLE
State	:	NY
Zip	:	11738-2064
Country	:	US
Telephone Number	:	631-451-1504
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 ANDREWS AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-6001
Country	:	US
Telephone Number	:	718-561-5300
Fax Number	:

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

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	08/15/2012

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