Provider Demographics
NPI:1043318819
Name:KIERNAN, HOWARD A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:A
Last Name:KIERNAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HOWARD
Other - Middle Name:A
Other - Last Name:KIERNAN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:903 PARK AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0338
Mailing Address - Country:US
Mailing Address - Phone:212-602-1800
Mailing Address - Fax:631-757-5119
Practice Address - Street 1:903 PARK AVE FL 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0362
Practice Address - Country:US
Practice Address - Phone:212-602-1800
Practice Address - Fax:631-757-5119
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099298207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B17430Medicare UPIN
NY641261Medicare ID - Type Unspecified