KENILWORTH PRIMARY CARE LLC NPI 1164793014

NPI Information

NPI: 1164793014
Provider Name: KENILWORTH PRIMARY CARE LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 31D2040770

Address:
66 S 21ST ST
KENILWORTH, NJ
ZIP 07033
Phone: (908) 276-9595
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KENILWORTH PRIMARY CARE LLC is a primary care clinic center in Kenilworth, NJ. KENILWORTH PRIMARY CARE LLC NPI is 1164793014. The provider is registered as an organization entity type.

The provider's business location address is:

66 S 21ST ST
KENILWORTH, NJ
ZIP 07033-626
Phone: (908) 276-9595
Fax: (908) 276-6807

The provider's authorized official is Bhavani Jeereddy .
The authorized official title is Sole Member and has the following contact phone number (908) 276-9595.

The CLIA number assigned to this NPI record is 31D2040770 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/24/2012 and was last updated on 1/24/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care		NEW JERSEY	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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