Provider Demographics
NPI:1538472527
Name:FOREMAN, KENNY C (LPN)
Entity Type:Individual
Prefix:MR
First Name:KENNY
Middle Name:C
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-3119
Mailing Address - Country:US
Mailing Address - Phone:716-855-1944
Mailing Address - Fax:
Practice Address - Street 1:499 MADISON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-3119
Practice Address - Country:US
Practice Address - Phone:716-855-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210965-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1548371065OtherMAXIM OF NEW YORK,LLC