Provider Demographics
NPI:1134159395
Name:MICHAEL F KERIN MD PC
Entity type:Organization
Organization Name:MICHAEL F KERIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:KERIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-793-0996
Mailing Address - Street 1:1 STONE PL
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3426
Mailing Address - Country:US
Mailing Address - Phone:914-793-0996
Mailing Address - Fax:914-793-9878
Practice Address - Street 1:1 STONE PL
Practice Address - Street 2:SUITE 303
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3426
Practice Address - Country:US
Practice Address - Phone:914-793-0996
Practice Address - Fax:914-793-9878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218921208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02103482Medicaid
NY02103482Medicaid