Provider Demographics
NPI:1255391017
Name:HERSHON, KENNETH (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:HERSHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 NEW HYDE PARK RD
Mailing Address - Street 2:201
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1214
Mailing Address - Country:US
Mailing Address - Phone:516-327-0850
Mailing Address - Fax:516-327-0920
Practice Address - Street 1:3003 NEW HYDE PARK RD
Practice Address - Street 2:201
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1214
Practice Address - Country:US
Practice Address - Phone:516-327-0850
Practice Address - Fax:516-327-0920
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084163-1207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
01013264NY01OtherANTHEM
NY2503329OtherGHI
2503329OtherCOMBINED WELFARE FUND
880059OtherAETNA
31269VOtherVYTRA
NY77A041OtherBLUE CROSS BLUE SHIELD
110005090OtherRAILROAD MEDICARE
NY5511594OtherCIGNA
N24263OtherGUARDIAN PHCS
N24263OtherGUARDIAN PHCS
880059OtherAETNA