Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 7149E | PA |
NPI | 1073737409 |
---|---|
Provider Name | Dr. Kenneth John Debenedictis |
First Address | Wayne, PA 19087-4623 |
Second Address | West Reading, PA 19611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |