Provider Demographics
NPI:1306940937
Name:JON D. KIRWIN, MD PC
Entity type:Organization
Organization Name:JON D. KIRWIN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KIRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-288-1875
Mailing Address - Street 1:PO BOX 3383
Mailing Address - Street 2:CHURCH STREET STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10008-3383
Mailing Address - Country:US
Mailing Address - Phone:718-288-1875
Mailing Address - Fax:212-321-6101
Practice Address - Street 1:86 EAST 49TH STREET
Practice Address - Street 2:KATZ BUILDING
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-288-1875
Practice Address - Fax:212-321-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1600622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01557735Medicaid
NY01557735Medicaid
NYF42615Medicare UPIN