Provider Demographics
NPI:1497921613
Name:JAY ARTHUR KERNER
Entity Type:Organization
Organization Name:JAY ARTHUR KERNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:KERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-223-4026
Mailing Address - Street 1:314 DEMOTT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1854
Mailing Address - Country:US
Mailing Address - Phone:516-223-4026
Mailing Address - Fax:516-223-8380
Practice Address - Street 1:314 DEMOTT AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1854
Practice Address - Country:US
Practice Address - Phone:516-223-4026
Practice Address - Fax:516-223-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003250261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00673363Medicaid
NYP35301Medicare PIN
NYT51049Medicare UPIN
NY1274520001Medicare NSC