Provider Demographics
NPI:1972657534
Name:EINBERG, KENNETH R (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:EINBERG
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 1:4250 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5716
Mailing Address - Country:US
Mailing Address - Phone:516-520-3962
Mailing Address - Fax:516-520-3792
Practice Address - Street 1:4250 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 21
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5716
Practice Address - Country:US
Practice Address - Phone:516-520-3962
Practice Address - Fax:516-520-3792
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1627162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01241932Medicaid
E48911Medicare UPIN
00111Medicare ID - Type Unspecified