Basic Information
Provider Information | |||||||||
NPI: | 1023084787 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KILKENNY | ||||||||
FirstName: | THOMAS | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 501 SEAVIEW AVE | ||||||||
Address2: |   | ||||||||
City: | STATEN ISLAND | ||||||||
State: | NY | ||||||||
PostalCode: | 103053436 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7189805700 | ||||||||
FaxNumber: | 7189805499 | ||||||||
Practice Location | |||||||||
Address1: | 501 SEAVIEW AVE | ||||||||
Address2: |   | ||||||||
City: | STATEN ISLAND | ||||||||
State: | NY | ||||||||
PostalCode: | 103053436 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7189805700 | ||||||||
FaxNumber: | 7189805499 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/23/2006 | ||||||||
LastUpdateDate: | 02/05/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 189698 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
ID | Type | State | Issuer | Description | 189698-B11 | 01 | NY | HEALTH FIRST | OTHER | 0005438548 | 01 | NY | AETNA | OTHER | 2599546 | 01 | NY | GHI | OTHER | 01755302 | 05 | NY |   | MEDICAID | 9801008 | 01 | NY | CIGNA | OTHER | P601947 | 01 | NY | OXFORD | OTHER | 4C4195 | 01 | NY | TOUCHSTONE | OTHER | 164527 | 01 | NY | ELDER PLAN | OTHER | 189698 | 01 | NY | HIP | OTHER | 310AQ1 | 01 | NY | BLUE CROSS | OTHER |