Provider Demographics
NPI:1285657502
Name:KAMLER, KENNETH MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MARK
Last Name:KAMLER
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 1:410 LAKEVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1101
Mailing Address - Country:US
Mailing Address - Phone:516-326-8810
Mailing Address - Fax:516-328-7165
Practice Address - Street 1:410 LAKEVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1101
Practice Address - Country:US
Practice Address - Phone:516-326-8810
Practice Address - Fax:516-328-7165
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1375591207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01695312Medicaid
NY26625POtherHIP HEALTH PLANS
NYP2679311OtherOXFORD HEALTH PLANS
NYB17150Medicare UPIN
NY62A901Medicare ID - Type Unspecified
NY26625POtherHIP HEALTH PLANS