Healthcare Provider Details

I. General information

NPI: 1659346682
Provider Name (Legal Business Name): KENSINGTON PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3904 16TH AVE
BROOKLYN NY
11218-5500
US

IV. Provider business mailing address

PO BOX 190421
BROOKLYN NY
11219-0421
US

V. Phone/Fax

Practice location:
  • Phone: 718-435-1449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number146343
License Number StateNY

VIII. Authorized Official

Name: MAX BULMASH
Title or Position: DIRECTOR OFFICER
Credential:
Phone: 718-851-8080