MEDICARE: MS. KEIKO LEGER P.A.

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	363A00000X	Physician Assistant	016907	NY

General Provider Information

NPI Number	:	1730516170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KEIKO LEGER P.A.

Provider Business Mailing Address
First Line	:	248 SCRANTON AVE
Second Line	:
City	:	LYNBROOK
State	:	NY
Zip	:	11563-2916
Country	:	US
Telephone Number	:	718-869-6630
Fax Number	:

Provider Business Practice Location Address
First Line	:	3309 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2711
Country	:	US
Telephone Number	:	718-856-3600
Fax Number	:	718-282-1177

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

Provider Enumeration Date	:	09/30/2013
Last Update Date	:	02/21/2019

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