Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MA67585 | NJ |
NPI | 1023178522 |
---|---|
Provider Name | John Kennedy |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-4903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 06/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
679766 | (02) | NJ |