Healthcare Provider Details

I. General information

NPI: 1518458751
Provider Name (Legal Business Name): K & H MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HICKSVILLE RD
BETHPAGE NY
11714-3443
US

IV. Provider business mailing address

120 HICKSVILLE RD
BETHPAGE NY
11714-3443
US

V. Phone/Fax

Practice location:
  • Phone: 516-717-1817
  • Fax: 631-204-6446
Mailing address:
  • Phone: 516-717-1839
  • Fax: 631-204-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: ELIEZER HALPERT
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 212-734-6621