Provider Demographics
NPI:1104335926
Name:HASKIN, KENT BYRON
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:BYRON
Last Name:HASKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:CLAVERACK
Mailing Address - State:NY
Mailing Address - Zip Code:12513-0415
Mailing Address - Country:US
Mailing Address - Phone:518-851-5421
Mailing Address - Fax:518-851-5421
Practice Address - Street 1:526 RT. 23 B
Practice Address - Street 2:
Practice Address - City:CLAVERACK
Practice Address - State:NY
Practice Address - Zip Code:12513
Practice Address - Country:US
Practice Address - Phone:518-851-5421
Practice Address - Fax:518-851-5421
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies