Provider Demographics
NPI:1275646580
Name:ZIPKIN, KENNETH A (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:ZIPKIN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SCHOOL ST
Mailing Address - Street 2:REAR
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542
Mailing Address - Country:US
Mailing Address - Phone:516-671-3131
Mailing Address - Fax:516-671-3172
Practice Address - Street 1:30 SCHOOL ST
Practice Address - Street 2:REAR
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-671-3131
Practice Address - Fax:516-671-3172
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029010DDS1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00497576Medicaid