MEDICARE: DR. JESSICA KAGANSKIY AU.D.

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	237600000X	Audiologist-Hearing Aid Fitter	003116	NY

General Provider Information

NPI Number	:	1467180448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA KAGANSKIY AU.D.

Provider Business Mailing Address
First Line	:	209 AVENUE P STE 2A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4982
Country	:	US
Telephone Number	:	718-421-2782
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 AVENUE P STE 2A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4982
Country	:	US
Telephone Number	:	718-421-2782
Fax Number	:

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

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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