Provider Demographics
NPI:1003016007
Name:FENG, KATHY (AUD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:FENG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MOTT STREET
Mailing Address - Street 2:STE 509
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:212-966-3886
Mailing Address - Fax:212-966-2886
Practice Address - Street 1:726 60TH STREET
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-569-0106
Practice Address - Fax:718-569-2190
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002150231H00000X
NY14000025780237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02912958Medicaid
NY02912958Medicaid