1023084787 NPI number — THOMAS M KILKENNY DO

Table of content: THOMAS M KILKENNY DO (NPI 1023084787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023084787 NPI number — THOMAS M KILKENNY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILKENNY
Provider First Name:
THOMAS
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1023084787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 SEAVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10305-3436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-980-5700
Provider Business Mailing Address Fax Number:
718-980-5499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 SEAVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10305-3436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-980-5700
Provider Business Practice Location Address Fax Number:
718-980-5499
Provider Enumeration Date:
02/23/2006

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: 207RP1001X , with the licence number:  189698 , 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: 189698-B11 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0005438548 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2599546 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01755302 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9801008 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P601947 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4C4195 . This is a "TOUCHSTONE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 164527 . This is a "ELDER PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 189698 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 310AQ1 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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