Provider Demographics
NPI:1629050869
Name:KERNER, JAY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:A
Last Name:KERNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 DEMOTT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1854
Mailing Address - Country:US
Mailing Address - Phone:516-223-4026
Mailing Address - Fax:510-223-8380
Practice Address - Street 1:314 DEMOTT AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1854
Practice Address - Country:US
Practice Address - Phone:516-223-4026
Practice Address - Fax:510-223-8380
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003250213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00673363Medicaid
NY00673363Medicaid
T51049Medicare UPIN
NYP3530100Medicare PIN