Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 25MB06380300 | NJ |
NPI | 1033125315 |
---|---|
Provider Name | Dr. Kenneth A Liss |
First Address | Eatontown, NJ 07724-2268 |
Second Address | Eatontown, NJ 07724-2268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 06/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7014902 | (05) | NJ |
G33253 | (02) |