Provider Demographics
NPI:1770664419
Name:BRISKIN, KENNETH B (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:BRISKIN
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 1:2112 PROVIDENCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013
Mailing Address - Country:US
Mailing Address - Phone:610-874-5366
Mailing Address - Fax:610-874-8448
Practice Address - Street 1:2112 PROVIDENCE AVENUE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-874-5366
Practice Address - Fax:610-874-8448
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061342L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0284044000OtherIBC HMO
PA000814002OtherIBC PPO
PA814002Medicare PIN
PAG07370Medicare UPIN
PA000814002OtherIBC PPO
G07370Medicare UPIN