Provider Demographics
NPI:1912012345
Name:KEMP, SHARAGIM (DO)
Entity Type:Individual
Prefix:
First Name:SHARAGIM
Middle Name:
Last Name:KEMP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 5TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5631
Mailing Address - Country:US
Mailing Address - Phone:646-880-4465
Mailing Address - Fax:845-475-9938
Practice Address - Street 1:126 5TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5631
Practice Address - Country:US
Practice Address - Phone:646-880-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9790207Q00000X
SC82226207Q00000X
PAOS020118207Q00000X
FLOS16194207Q00000X
ARE-12440207Q00000X
OH34.014035207Q00000X
VA0102205798207Q00000X
NC2019-02038207Q00000X
IADO-05437207Q00000X
GA84002207Q00000X
TN3783207Q00000X
AZ008059207Q00000X
CA20A17775207Q00000X
KY04620207Q00000X
NY236415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02672860Medicaid
NY2875PZWVQ1Medicare PIN
I41678Medicare UPIN
NY02672860Medicaid