Provider Demographics
NPI:1255868667
Name:KENIGSBERG, AKIVA (DPM)
Entity Type:Individual
Prefix:
First Name:AKIVA
Middle Name:
Last Name:KENIGSBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 147TH ST # 401B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2003
Mailing Address - Country:US
Mailing Address - Phone:908-472-9149
Mailing Address - Fax:
Practice Address - Street 1:7101 147TH ST # 401B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2003
Practice Address - Country:US
Practice Address - Phone:908-472-9149
Practice Address - Fax:908-472-9149
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN007086213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery