MEDICARE: CRAIG D MCKERNIN PA

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	363A00000X	Physician Assistant	001302-1	NY

General Provider Information

NPI Number	:	1477592780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG D MCKERNIN PA

Provider Business Mailing Address
First Line	:	38 6TH AVE
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-2207
Country	:	US
Telephone Number	:	718-439-4358
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 FLATBUSH AVENUE EXT
Second Line	:	8TH FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1906
Country	:	US
Telephone Number	:	718-439-4358
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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Directions to “ CRAIG D MCKERNIN PA” Practice Location

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