Provider Demographics
NPI:1831115880
Name:CROEN, KENNETH D (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
Last Name:CROEN
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 1:259 HEATHCOTE RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4523
Mailing Address - Country:US
Mailing Address - Phone:914-723-8100
Mailing Address - Fax:914-219-1928
Practice Address - Street 1:550 MAMARONECK AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1634
Practice Address - Country:US
Practice Address - Phone:914-723-8100
Practice Address - Fax:914-219-1928
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146776207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01429381Medicaid
NY01429381Medicaid
NY43H9010Medicare ID - Type Unspecified