Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | N004934 | NY |
N | 222Z00000X | Podiatrist | N004934 | NY |
N | 213ES0131X | Foot Surgery | N004934 | NY |
NPI | 1174685978 |
---|---|
Provider Name | Dr. Kenneth L. Meserole JR. |
First Address | Plainview, NY 11803-5809 |
Second Address | Plainview, NY 11803-5809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 08/07/2007 |