Basic Information
| Provider Information | |||||||||
| NPI: | 1003016007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FENG | ||||||||
| FirstName: | KATHY | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 MOTT STREET | ||||||||
| Address2: | STE 509 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129663886 | ||||||||
| FaxNumber: | 2129662886 | ||||||||
| Practice Location | |||||||||
| Address1: | 726 60TH STREET | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185690106 | ||||||||
| FaxNumber: | 7185692190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2007 | ||||||||
| LastUpdateDate: | 04/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 002150 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | 14000025780 | NY | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 02912958 | 05 | NY | MEDICAID |