MEDICARE: DR. KENNETH A. EGOL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0801X	Orthopaedic Trauma Physician	199801	NY
2	207X00000X	Orthopaedic Surgery Physician	199801	NY

General Provider Information

NPI Number	:	1679542757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH A. EGOL M.D.

Provider Business Mailing Address
First Line	:	301 E 17TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-3804
Country	:	US
Telephone Number	:	212-598-3889
Fax Number	:	212-598-6015

Provider Business Practice Location Address
First Line	:	240 E 18TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-3605
Country	:	US
Telephone Number	:	212-598-3889
Fax Number	:	212-598-6015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	03/26/2021

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