Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00353700 | NJ |
N | 111NS0005X | Chiropractic Sports Physician | 38MC00353700 | NJ |
NPI | 1033149729 |
---|---|
Provider Name | Dr. Matthew P Kemenosh |
First Address | Ocean City, NJ 08226-4008 |
Second Address | Ocean City, NJ 08226-4008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 25/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
223580687 | (02) | NJ |