Provider Demographics
NPI:1619203924
Name:BRENT THOMAS KEMPF, D.P.M.
Entity Type:Organization
Organization Name:BRENT THOMAS KEMPF, D.P.M.
Other - Org Name:SAYVILLE FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KEMPF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-567-2888
Mailing Address - Street 1:110 LAKELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1912
Mailing Address - Country:US
Mailing Address - Phone:631-567-2888
Mailing Address - Fax:631-567-2369
Practice Address - Street 1:110 LAKELAND AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1912
Practice Address - Country:US
Practice Address - Phone:631-567-2888
Practice Address - Fax:631-567-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005677332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
137686OtherVYTRA
NY02093709Medicaid
P3265675OtherOXFORD
1499422OtherGHI/EMBLEM HEALTH
PJ8822OtherBLUE CROSS BLUE SHIELD
7232934OtherCIGNA
7232934OtherCIGNA
PJ8822OtherBLUE CROSS BLUE SHIELD