=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629050869
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAY A KERNER DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2005
-----------------------------------------------------
Last Update Date | 08/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 314 DEMOTT AVE
-----------------------------------------------------
City | ROCKVILLE CENTRE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11570-1854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-223-4026
-----------------------------------------------------
Fax | 510-223-8380
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 314 DEMOTT AVE
-----------------------------------------------------
City | ROCKVILLE CENTRE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11570-1854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-223-4026
-----------------------------------------------------
Fax | 510-223-8380
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | N003250
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------