MEDICARE: DR. ROBERT KAZENOFF M.D., F.A.C.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	147530	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26E931	OTHER	NY	BLUE CROSS BLUE SHIELD
2	CP485	OTHER	NY	OXFORD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	112495	OTHER	NY	VYTRA
5	4248318	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1649266073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT KAZENOFF M.D., F.A.C.P.

Provider Business Mailing Address
First Line	:	205 E MAIN ST
Second Line	:	SUITE 2-7B
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2923
Country	:	US
Telephone Number	:	631-351-9100
Fax Number	:	631-351-9110

Provider Business Practice Location Address
First Line	:	205 E MAIN ST
Second Line	:	SUITE 2-7B
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2923
Country	:	US
Telephone Number	:	631-351-9100
Fax Number	:	631-351-9110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	03/09/2012

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