Provider Demographics
NPI:1134459886
Name:RADNER, KENNETH (BSC, CPO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:RADNER
Suffix:
Gender:M
Credentials:BSC, CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CORNELL DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3022
Mailing Address - Country:US
Mailing Address - Phone:631-543-1414
Mailing Address - Fax:
Practice Address - Street 1:2094 FRONT ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1709
Practice Address - Country:US
Practice Address - Phone:516-357-9113
Practice Address - Fax:516-357-9186
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist