MEDICARE: KAYLA C CYNAMON P.T.

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	208100000X	Physical Medicine & Rehabilitation Physician	013856	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	QQ643	OTHER	NY	EMPIRE BCBS

General Provider Information

NPI Number	:	1649329715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA C CYNAMON P.T.

Provider Business Mailing Address
First Line	:	1344 E 34TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4820
Country	:	US
Telephone Number	:	718-336-4440
Fax Number	:	718-336-4411

Provider Business Practice Location Address
First Line	:	1894 HARING ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3210
Country	:	US
Telephone Number	:	718-336-4440
Fax Number	:	718-336-4411

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	09/07/2022

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