Provider Demographics
NPI:1699886465
Name:NYER, KENNETH LLOYD (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LLOYD
Last Name:NYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1610 WILLIAMSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6289
Mailing Address - Country:US
Mailing Address - Phone:718-409-6400
Mailing Address - Fax:718-823-9119
Practice Address - Street 1:1610 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6289
Practice Address - Country:US
Practice Address - Phone:718-409-6400
Practice Address - Fax:718-823-9119
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY163811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY95D951Medicare ID - Type Unspecified
NYA65020Medicare UPIN