Basic Information
Provider Information
NPI: 1518458751
EntityType: 2
ReplacementNPI:  
OrganizationName: K & H MEDICAL PLLC
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Mailing Information
Address1: 120 HICKSVILLE RD
Address2:  
City: BETHPAGE
State: NY
PostalCode: 117143443
CountryCode: US
TelephoneNumber: 5167171839
FaxNumber: 6312046446
Practice Location
Address1: 120 HICKSVILLE RD
Address2:  
City: BETHPAGE
State: NY
PostalCode: 117143443
CountryCode: US
TelephoneNumber: 5167171817
FaxNumber: 6312046446
Other Information
ProviderEnumerationDate: 05/23/2018
LastUpdateDate: 05/10/2021
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: HALPERT
AuthorizedOfficialFirstName: ELIEZER
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AuthorizedOfficialTitleorPosition: AUTHORIZED OFFICIAL
AuthorizedOfficialTelephone: 5167171839
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate: 05/10/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2086S0129X NYN193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
2085R0204X NYY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology

ID Information
IDTypeStateIssuerDescription
0538501105NY MEDICAID


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