1346560455 NPI number — DR. KENTON HOWARD FIBEL M.D.

Table of content: DR. KENTON HOWARD FIBEL M.D. (NPI 1346560455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346560455 NPI number — DR. KENTON HOWARD FIBEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIBEL
Provider First Name:
KENTON
Provider Middle Name:
HOWARD
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:
1346560455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 E 70TH ST
Provider Second Line Business Mailing Address:
ATTENTION: KENTON FIBEL, MD
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-4823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-714-6323
Provider Business Mailing Address Fax Number:
646-714-6376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 PARK TERRACE
Provider Second Line Business Practice Location Address:
100, 125, 400
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90045-9004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-665-7200
Provider Business Practice Location Address Fax Number:
646-714-6376
Provider Enumeration Date:
06/11/2010

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: 207QS0010X , with the licence number:  A118684 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QS0010X , with the licence number: 268986 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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