Provider Demographics
NPI:1578785341
Name:BIEGELEISEN, KEN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:
Last Name:BIEGELEISEN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E 73RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3556
Mailing Address - Country:US
Mailing Address - Phone:212-717-4422
Mailing Address - Fax:
Practice Address - Street 1:133 E 73RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3556
Practice Address - Country:US
Practice Address - Phone:212-717-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138411202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00730832Medicaid
NY00730832Medicaid