Healthcare Provider Details

I. General information

NPI: 1043274194
Provider Name (Legal Business Name): KENNETH OURIEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 72ND STREET 14H
NEW YORK NY
10023
US

IV. Provider business mailing address

14 E 60TH ST SUITE 1201
NEW YORK NY
10022-1006
US

V. Phone/Fax

Practice location:
  • Phone: 917-446-5373
  • Fax:
Mailing address:
  • Phone: 917-446-5373
  • Fax: 646-375-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35075488O
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: