Provider Demographics
NPI:1811924806
Name:KAYNAN, ARIEH (MD)
Entity type:Individual
Prefix:
First Name:ARIEH
Middle Name:
Last Name:KAYNAN
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 1:18815 RADNOR RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1018
Mailing Address - Country:US
Mailing Address - Phone:718-479-0582
Mailing Address - Fax:718-464-1515
Practice Address - Street 1:18815 RADNOR RD
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1018
Practice Address - Country:US
Practice Address - Phone:718-479-0582
Practice Address - Fax:718-464-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1151812086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00211761Medicaid
NYB13284Medicare UPIN
NY4989DXMedicare ID - Type Unspecified