Provider Demographics
NPI:1659568632
Name:WARREN L. KENT D.P.M. P.C.
Entity Type:Organization
Organization Name:WARREN L. KENT D.P.M. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-928-1815
Mailing Address - Street 1:136 TERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1330
Mailing Address - Country:US
Mailing Address - Phone:631-928-1815
Mailing Address - Fax:631-928-2945
Practice Address - Street 1:136 TERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1330
Practice Address - Country:US
Practice Address - Phone:631-928-1815
Practice Address - Fax:631-928-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003191213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00633069Medicaid
NYT51006Medicare UPIN
NY00633069Medicaid
NYPSW521Medicare PIN
NYDN1908Medicare PIN