Provider Demographics
NPI:1821298704
Name:ROBERT KAZENOFF MD PC
Entity Type:Organization
Organization Name:ROBERT KAZENOFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZENOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-351-9100
Mailing Address - Street 1:PO BOX 1598
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-0659
Mailing Address - Country:US
Mailing Address - Phone:631-351-9100
Mailing Address - Fax:631-351-9110
Practice Address - Street 1:205 E MAIN ST
Practice Address - Street 2:SUITE 2-7 B
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2923
Practice Address - Country:US
Practice Address - Phone:631-351-9100
Practice Address - Fax:631-351-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WEX161Medicare PIN