1578564738 NPI number — DR. JONATHAN R KEMP M.D.

Table of content: DR. JONATHAN R KEMP M.D. (NPI 1578564738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578564738 NPI number — DR. JONATHAN R KEMP M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEMP
Provider First Name:
JONATHAN
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578564738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 NOTT ST
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12308-2589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-374-3123
Provider Business Mailing Address Fax Number:
518-374-9711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 NOTT ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12308-2589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-374-3123
Provider Business Practice Location Address Fax Number:
518-374-9711
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  199471-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000086338 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000405012001 . This is a "BLUE SHIELD NENY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10001037 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: CAN1994714 . This is a "WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000405012002 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01561504 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040426006641 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 05302 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110160500 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6T854 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33570H . This is a "FIDELIS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9689400 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 199471-1 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: G09312 . This is a "AMERICAN PROGRESSIVE TODA" identifier . This identifiers is of the category "OTHER".
  • Identifier: JK06T85420 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: JK06T85410 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CAN1994714 . This is a "NO FAULT" identifier . This identifiers is of the category "OTHER".




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