Healthcare Provider Details

I. General information

NPI: 1679542757
Provider Name (Legal Business Name): KENNETH A. EGOL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 18TH ST
NEW YORK NY
10003-3605
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 TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number199801
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number199801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: