Provider Demographics
NPI:1295750099
Name:HAUSKNECHT, KERIN B (MD)
Entity type:Individual
Prefix:
First Name:KERIN
Middle Name:B
Last Name:HAUSKNECHT
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:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-0209
Mailing Address - Country:US
Mailing Address - Phone:516-374-4451
Mailing Address - Fax:516-374-1987
Practice Address - Street 1:23 LANGDON PL
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2414
Practice Address - Country:US
Practice Address - Phone:516-374-4451
Practice Address - Fax:516-674-1987
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202181204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG48823Medicare UPIN
NY96X081Medicare PIN
NYA400063940Medicare PIN
NYG400065196Medicare PIN
NY6514UDMedicare PIN
NYG300000129Medicare PIN