Provider Demographics
NPI:1093996928
Name:VAN KEMPEN, JON PAUL (PT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:PAUL
Last Name:VAN KEMPEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AGWAY DR
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-9637
Mailing Address - Country:US
Mailing Address - Phone:518-326-9065
Mailing Address - Fax:518-326-9064
Practice Address - Street 1:1 AGWAY DR
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-9637
Practice Address - Country:US
Practice Address - Phone:518-326-9065
Practice Address - Fax:518-326-9064
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB6383Medicare PIN