MEDICARE: MRS. KARA LYNN GARDNER MS

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	170300000X	Genetic Counselor (M.S.)	2002119

General Provider Information

NPI Number	:	1528048444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARA LYNN GARDNER MS

Provider Business Mailing Address
First Line	:	22 RIVER TER
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10282-1149
Country	:	US
Telephone Number	:	212-608-5292
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 W 12TH ST
Second Line	:	NR925, GENETICS
City	:	NEW YORK
State	:	NY
Zip	:	10011-8202
Country	:	US
Telephone Number	:	212-604-7692
Fax Number	:	212-604-3899

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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