MEDICARE: MS. KATHY ANNETT GARDINI FPA-C

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	175T00000X	Peer Specialist	0247	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	:	1700404001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY ANNETT GARDINI FPA-C

Provider Business Mailing Address
First Line	:	1914 BROOKHAVEN AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3626
Country	:	US
Telephone Number	:	718-869-7923
Fax Number	:	718-869-8701

Provider Business Practice Location Address
First Line	:	1914 BROOKHAVEN AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3626
Country	:	US
Telephone Number	:	718-869-7923
Fax Number	:	718-869-8701

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

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	11/27/2023

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