Healthcare Provider Details

I. General information

NPI: 1285870998
Provider Name (Legal Business Name): KENNETH A EGOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 17TH ST
NEW YORK NY
10003-3804
US

IV. Provider business mailing address

301 E 17TH ST
NEW YORK NY
10003-3804
US

V. Phone/Fax

Practice location:
  • Phone: 212-598-3889
  • Fax: 212-598-6015
Mailing address:
  • Phone: 212-598-3889
  • Fax: 212-598-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number199801
License Number StateNY

VIII. Authorized Official

Name: KENNETH A EGOL
Title or Position: ORTHOPAEDIC SURGERY
Credential: M.D.
Phone: 212-598-3889