Provider Demographics
NPI:1205834041
Name:AUSTIN, KENNETH S (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 AIRPORT EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-5288
Mailing Address - Country:US
Mailing Address - Phone:845-262-5313
Mailing Address - Fax:845-262-5330
Practice Address - Street 1:327 ROUTE 59
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952
Practice Address - Country:US
Practice Address - Phone:845-356-2900
Practice Address - Fax:845-356-7797
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179160207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY569G91OtherEMPIRE BCBS (STONY POINT)
NYRS359OtherOXFORD
NY4537881OtherAETNA PPO#
NY569G92OtherEMPIRE BCBS (MONROE)
NY0500976OtherGHI PPO
NY569G93OtherEMPIRE BCBS (AIRMONT)
NY0474841OtherAETNA HMO#
NY319418OtherMVP (AIRMONT/STONY POINT)
NY0D0561OtherHEALTHNET
NY132721370OtherTAX ID#
NY187196OtherMVP (MONROE)
NY01490573Medicaid
NY200032198OtherRAILROAD MEDICARE
NJ095281UN2Medicare PIN
NY187196OtherMVP (MONROE)
NYRS359OtherOXFORD