Provider Demographics
NPI:1619968161
Name:KEFALOS, JOHN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:KEFALOS
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 1:777 SUNRISE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2950
Mailing Address - Country:US
Mailing Address - Phone:516-887-3516
Mailing Address - Fax:
Practice Address - Street 1:777 SUNRISE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2950
Practice Address - Country:US
Practice Address - Phone:516-887-3516
Practice Address - Fax:516-887-0331
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1526382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY152638OtherHIP
NY62259790OtherMULTIPLAN
NY640026OtherHEALTHCARE PARTNERS
NYAS1069OtherOXFORD
NY112573413OtherCCN,CHO HUM,FRSTHELTH,HOR
NY68866OtherPHCS
NYAD00676OtherMDNY
NY01572861Medicaid
NYNS0001847OtherSELECT PRO
NY1917532005OtherCIGNA
NYOC3470OtherHEALTHNET
NYCPNN1526383OtherWORKERS COMP NO FAULT
NY112573413OtherMAG,OHP,UHC,EMPIRE
NY3099813OtherGHI
NY000000056378OtherGHI HMO
NY613OtherVYTRA
NY000000056378OtherGHI HMO
NY152638OtherHIP
NY68866OtherPHCS