Provider Demographics
NPI:1912122904
Name:JOHN KENUL HEARING SERVICES LLC
Entity type:Organization
Organization Name:JOHN KENUL HEARING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:KENUL
Authorized Official - Suffix:
Authorized Official - Credentials:BC HIS ACA
Authorized Official - Phone:718-274-4327
Mailing Address - Street 1:38-03 31ST AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103
Mailing Address - Country:US
Mailing Address - Phone:718-274-4327
Mailing Address - Fax:718-274-6339
Practice Address - Street 1:38-03 31ST AVENUE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103
Practice Address - Country:US
Practice Address - Phone:718-274-4327
Practice Address - Fax:718-274-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15000010770332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01643329Medicaid