MEDICARE: PENINA KALLUS

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	235Z00000X	Speech-Language Pathologist		NY

General Provider Information

NPI Number	:	1528789930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENINA KALLUS

Provider Business Mailing Address
First Line	:	1327 E 35TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5429
Country	:	US
Telephone Number	:	718-490-5581
Fax Number	:

Provider Business Practice Location Address
First Line	:	1327 E 35TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5429
Country	:	US
Telephone Number	:	718-490-5581
Fax Number	:

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

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/06/2022

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Directions to “ PENINA KALLUS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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