Provider Demographics
NPI:1043470834
Name:SMALL, KEVIN HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:HOWARD
Last Name:SMALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:125 MINEOLA AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2042
Mailing Address - Country:US
Mailing Address - Phone:314-477-6255
Mailing Address - Fax:
Practice Address - Street 1:125 MINEOLA AVE
Practice Address - Street 2:STE 200
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2042
Practice Address - Country:US
Practice Address - Phone:516-616-5500
Practice Address - Fax:888-502-6582
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-15
Last Update Date:2017-03-07
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Provider Licenses
StateLicense IDTaxonomies
NY266256208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY266256OtherNYS LICENSE