Active NPI
Kenneth Shen, MD
- Pediatrics Physician
- New York, NY
National Provider Identifier
1255838207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 312636-01
- Practice address
- 1468 Madison Ave BLDG 4TH
New York, NY 10029-6508 - Phone
- (212) 659-8559
- NPI assigned
- Apr 6, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 312636-01 | NY | Primary |
Addresses
Primary practice location
1468 Madison Ave BLDG 4TH
New York, NY 10029-6508
Mailing address
333 Schermerhorn St Apt 45J
Brooklyn, NY 11217-3896
Phone (908) 256-1622
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190220002104 | NY | Order and Referring Only - Pediatric Medicine | 1052659885 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 312636-01 | NY | MD | Pediatrics Physician |
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719100800000",
"number": "1255838207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 SCHERMERHORN ST APT 45J",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112173896",
"telephone_number": "908-256-1622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1468 MADISON AVE BLDG 4TH",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100296508",
"telephone_number": "212-659-8559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEN",
"first_name": "KENNETH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-06",
"last_updated": "2024-06-23",
"certification_date": "2024-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "312636-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.