| Kenilworth Primary Care Llc | |
|
66 S 21st St Kenilworth NJ 07033-1626 | |
| (908) 276-9595 | |
| (908) 276-6807 |
| Full Name | Kenilworth Primary Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 66 S 21st St, Kenilworth, New Jersey |
| Authorized Official Name and Position | Bhavani Jeereddy (SOLE MEMBER) |
| Authorized Official Contact | 9082769595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenilworth Primary Care Llc 66 S 21st St Kenilworth NJ 07033-1626 Ph: (908) 276-9595 | Kenilworth Primary Care Llc 66 S 21st St Kenilworth NJ 07033-1626 Ph: (908) 276-9595 |
| NPI Number | 1164793014 |
|---|---|
| Provider Enumeration Date | 01/24/2012 |
| Last Update Date | 01/24/2012 |
| Medicare PECOS PAC ID | 9931368842 |
|---|---|
| Medicare Enrollment ID | O20120313000667 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164793014 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (New Jersey) | Primary |
| Provider Name | Bhavani Jeereddy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689833485 PECOS PAC ID: 0840459756 Enrollment ID: I20120313000681 |
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