MEDICARE: CHAYA MIRIAM KROEN

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689122046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAYA MIRIAM KROEN

Provider Business Mailing Address
First Line	:	5616 17TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1834
Country	:	US
Telephone Number	:	718-687-8662
Fax Number	:

Provider Business Practice Location Address
First Line	:	5616 17TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1834
Country	:	US
Telephone Number	:	718-687-8662
Fax Number	:

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

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	03/15/2019

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Directions to “ CHAYA MIRIAM KROEN ” Practice Location

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