Provider Demographics
NPI:1760470280
Name:KEMPIN, SANFORD J (MD)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:J
Last Name:KEMPIN
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:PO BOX 95000-2441
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2441
Mailing Address - Country:US
Mailing Address - Phone:212-367-1864
Mailing Address - Fax:212-604-6038
Practice Address - Street 1:325 W 15TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5903
Practice Address - Country:US
Practice Address - Phone:212-367-1864
Practice Address - Fax:212-604-6038
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02057894Medicaid
NYB125506Medicare UPIN
NY810571Medicare ID - Type Unspecified