Provider Demographics
NPI:1437150406
Name:KENT, WARREN L (DPM)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:L
Last Name:KENT
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 1:136 TERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1330
Mailing Address - Country:US
Mailing Address - Phone:631-928-1815
Mailing Address - Fax:
Practice Address - Street 1:136 TERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1330
Practice Address - Country:US
Practice Address - Phone:631-928-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003191213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY692299OtherUNITED HEALTH CARE
NY111898OtherUSHC (HMO)
NYCS097OtherOXFORD
NY00633069Medicaid
NY6144145013OtherCIGNA
NY4263796OtherAETNA
NY1499628OtherGHI
NYPH1231OtherBCBS
NYP-45351494OtherMULTIPLAN
NYPH1231OtherBCBS
NY6144145013OtherCIGNA
NY692299OtherUNITED HEALTH CARE