Provider Demographics
NPI:1659483246
Name:KEMPF, BRENT THOMAS (DPM)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:THOMAS
Last Name:KEMPF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:B
Other - Middle Name:THOMAS
Other - Last Name:KEMPF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005677213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1499422OtherGHI
2033856OtherUNITED HEALTHCARE
N005677A87OtherHEALTHFIRST
NY02093709Medicaid
137686OtherVYTRA
P3265675OtherOXFORD
7232934OtherCIGNA
PJ8821OtherBLUE CROSS BLUE SHIELD
NY02093709Medicaid
NYU79174Medicare UPIN