MEDICARE: MR. KEREM DEGIRMENCIOGLU

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1568279917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEREM DEGIRMENCIOGLU

Provider Business Mailing Address
First Line	:	299 BROADWAY STE 905
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-1960
Country	:	US
Telephone Number	:	917-873-1022
Fax Number	:

Provider Business Practice Location Address
First Line	:	4522 41ST ST APT 1
Second Line	:
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-3419
Country	:	US
Telephone Number	:	646-573-7451
Fax Number	:

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

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	12/18/2024

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