Provider Demographics
NPI:1003977125
Name:KERSTEN, ROGER (DO)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:KERSTEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1203
Mailing Address - Country:US
Mailing Address - Phone:516-795-2626
Mailing Address - Fax:516-799-7451
Practice Address - Street 1:510 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1203
Practice Address - Country:US
Practice Address - Phone:516-795-2626
Practice Address - Fax:516-799-7451
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177943207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E87389Medicare UPIN
41F301Medicare ID - Type Unspecified