Dodge, Kenneth R

Dodge, Kenneth R is an individual health care provider with primary practice located at 200 Pantiago Place Ste J, East Hampton NY 11937. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Dodge, Kenneth R can be contacted via phone (631) 324-7700.

Contact Information

Primary practice address
200 Pantiago Place Ste J East Hampton NY 11937
Phone: (631) 324-7700
Fax: (631) 324-7701
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0001001 New York
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 0001001 New York

Profile Details

NPI number 1952366601
LBN Legal business name Dodge, Kenneth R
Credentials RPAC
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 18th, 2006
Last updated Apr 12th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952366601 NPPES
New York MEDICAID 01271329

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