Provider Demographics
NPI:1023084787
Name:KILKENNY, THOMAS M (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:KILKENNY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3436
Mailing Address - Country:US
Mailing Address - Phone:718-980-5700
Mailing Address - Fax:718-980-5499
Practice Address - Street 1:501 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-980-5700
Practice Address - Fax:718-980-5499
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189698207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY189698-B11OtherHEALTH FIRST
NY0005438548OtherAETNA
NY2599546OtherGHI
NY01755302Medicaid
NY9801008OtherCIGNA
NYP601947OtherOXFORD
NY4C4195OtherTOUCHSTONE
NY164527OtherELDER PLAN
NY189698OtherHIP
NY310AQ1OtherBLUE CROSS
NY16U531Medicare PIN
NY9801008OtherCIGNA