Active NPI
Alan Michael Kisner, M.D.
- Specialist
- Huntington, NY
National Provider Identifier
1790766673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1216841
- Practice address
- 100 E Main St
Huntington, NY 11743-2816 - Phone
- (631) 424-4004
- Fax
- (631) 424-4027
- NPI assigned
- Nov 8, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1216841 | NY | Primary |
Addresses
Primary practice location
100 E Main St
Huntington, NY 11743-2816
Mailing address
100 E Main St
Huntington, NY 11743-2816
Phone (631) 424-4004
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 |
|---|---|---|---|---|
| I20040424000293 | NY | Practitioner - Plastic and Reconstructive Surgery | 0840286720 | Practice locations: Huntington, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Plastic and Reconstructive Surgery
- Education
- Other, 1967
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
100 E Main St
Huntington, NY 11743-2847
Phone (631) 424-4004
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Mastectomy | 1-10 |
| Melanoma (skin cancer) excision | 1-10 |
| Removal of tissue | 1-10 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1216841 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213747200000",
"number": "1790766673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E MAIN ST",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117432816",
"telephone_number": "631-424-4004",
"fax_number": "631-424-4027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E MAIN ST",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117432816",
"telephone_number": "631-424-4004",
"fax_number": "631-424-4027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISNER",
"first_name": "ALAN",
"middle_name": "MICHAEL",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-08",
"last_updated": "2008-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "1216841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntington, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.