MEDICARE: KARA SMALL

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1770875155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA SMALL

Provider Business Mailing Address
First Line	:	1554 NORTHERN BLVD
Second Line	:
City	:	MANHASSET
State	:	NY
Zip	:	11030-3006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1554 NORTHERN BLVD
Second Line	:
City	:	MANHASSET
State	:	NY
Zip	:	11030-3006
Country	:	US
Telephone Number	:	516-365-3996
Fax Number	:	516-365-4597

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

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	05/04/2011

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