Provider Demographics
NPI:1851357693
Name:FEUERSTEIN, KENNETH LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LAWRENCE
Last Name:FEUERSTEIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2704 GLENWOOD RD
Mailing Address - Street 2:MARK B. LEW, MD, LLC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2326
Mailing Address - Country:US
Mailing Address - Phone:718-859-6440
Mailing Address - Fax:718-434-0368
Practice Address - Street 1:2704 GLENWOOD RD
Practice Address - Street 2:MARK B. LEW, MD, LLC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2326
Practice Address - Country:US
Practice Address - Phone:718-859-6440
Practice Address - Fax:718-434-0368
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2012-02-28
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Provider Licenses
StateLicense IDTaxonomies
NY1864552080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01336805Medicaid
NY01336805Medicaid