Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | MCO2777 | NJ |
NPI | 1306872247 |
---|---|
Provider Name | Dr. Ronald V Kern |
First Address | Boonton, NJ 07005-1709 |
Second Address | Boonton, NJ 07005-1709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 22/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3370003 | (05) | NJ |
P00787233 | MEDICARE PTAN (01) | NJ |