Provider Demographics
NPI:1467678003
Name:KIRSNER, KENNETH M (CRNA)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:KIRSNER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST. SUITE K3502
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203
Mailing Address - Country:US
Mailing Address - Phone:315-339-1959
Mailing Address - Fax:315-339-1975
Practice Address - Street 1:1001 MAIN ST. SUITE K3502
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:239-848-2098
Practice Address - Fax:239-939-0151
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA1079367500000X
OH14316367500000X
NMCRNA-01432367500000X
TXAP104135367500000X
FL9242983367500000X
NY337141367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308344600Medicaid
FLG4242OtherBSFL