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KENDALL PARK MEDICAL GROUP NPI 1477784155


NPI Information

NPI: 1477784155
Provider Name: KENDALL PARK MEDICAL GROUP
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 31D0870096

Address:
3 STANWORTH RD # A
KENDALL PARK, NJ
ZIP 08824
Phone: (732) 940-0505
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KENDALL PARK MEDICAL GROUP is a family medicine in Kendall Park, NJ. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. KENDALL PARK MEDICAL GROUP NPI is 1477784155. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3 STANWORTH RD # A
KENDALL PARK, NJ
ZIP 08824-003
Phone: (732) 940-0505
Fax: (732) 940-1997

The provider's authorized official is Jaime F Lara .
The authorized official title is Physician and has the following contact phone number (732) 940-0505.

The CLIA number assigned to this NPI record is 31D0870096 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/29/2009 and was last updated on 7/29/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine25MA04235300NEW JERSEYYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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