Provider Demographics
NPI:1093746398
Name:KANER, RICHARD P (MA F-AAA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:KANER
Suffix:
Gender:M
Credentials:MA F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8502 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4608
Mailing Address - Country:US
Mailing Address - Phone:718-745-6363
Mailing Address - Fax:718-836-2223
Practice Address - Street 1:8502 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4608
Practice Address - Country:US
Practice Address - Phone:718-745-6363
Practice Address - Fax:718-836-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM01011Medicare PIN
NYS06380Medicare UPIN