Provider Demographics
NPI:1033219951
Name:KINGSWAY ORTHOPEDIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KINGSWAY ORTHOPEDIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SENAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-252-7324
Mailing Address - Street 1:3156 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2616
Mailing Address - Country:US
Mailing Address - Phone:718-252-7324
Mailing Address - Fax:718-951-7371
Practice Address - Street 1:3156 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2616
Practice Address - Country:US
Practice Address - Phone:718-252-7324
Practice Address - Fax:718-951-7371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173063207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB55521Medicare PIN
NYE20335Medicare UPIN