Provider Demographics
NPI:1629144506
Name:KANTROWITZ, GARY (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:KANTROWITZ
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 1:11940 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2600
Mailing Address - Country:US
Mailing Address - Phone:516-551-3303
Mailing Address - Fax:212-644-2111
Practice Address - Street 1:11940 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2600
Practice Address - Country:US
Practice Address - Phone:516-551-3303
Practice Address - Fax:212-644-2111
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003508213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00939942Medicaid
PAT32167Medicare UPIN