Provider Demographics
NPI:1508892258
Name:KERPEN, HOWARD OWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:OWEN
Last Name:KERPEN
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 1:1575 HILLSIDE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2501
Mailing Address - Country:US
Mailing Address - Phone:516-437-1616
Mailing Address - Fax:516-354-6048
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2501
Practice Address - Country:US
Practice Address - Phone:516-437-1616
Practice Address - Fax:516-354-6048
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117070207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112458161Other1199 NATIONAL BENEFIT FUN
NY340911OtherEMPIRE BLUE SHIELD
NY46600OtherMDNY
NY2C8018OtherHEALTHNET
NY3564047001OtherCIGNA
NYAP434OtherOXFORD
NY880672OtherAETNA HMO
NY36098OtherVYTRA
NM4260267OtherAETNA PPO
NY1226704OtherUNITED HEALTHCARE
NY1226704OtherUNITED HEALTHCARE
NYW03751Medicare ID - Type UnspecifiedMEDICARE