Provider Demographics
NPI:1811052442
Name:KISIEL, DENNIS L (PHD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:KISIEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 JORALEMON ST
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4709
Mailing Address - Country:US
Mailing Address - Phone:718-858-6734
Mailing Address - Fax:718-875-8162
Practice Address - Street 1:142 JORALEMON ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4709
Practice Address - Country:US
Practice Address - Phone:718-858-6734
Practice Address - Fax:718-875-8162
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000655-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000655-1OtherLICENSE NUMBER
NYMO1432Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION #