Healthcare Provider Details

I. General information

NPI: 1578785341
Provider Name (Legal Business Name): KEN BIEGELEISEN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E 73RD ST
NEW YORK NY
10021-3556
US

IV. Provider business mailing address

133 E 73RD ST
NEW YORK NY
10021-3556
US

V. Phone/Fax

Practice location:
  • Phone: 212-717-4422
  • Fax:
Mailing address:
  • Phone: 212-717-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number138411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: