1750472205 NPI number — KENNETH W ORDENE MD

Table of content: KENNETH W ORDENE MD (NPI 1750472205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750472205 NPI number — KENNETH W ORDENE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORDENE
Provider First Name:
KENNETH
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750472205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 IRON BRIDGE ROAD
Provider Second Line Business Mailing Address:
SUITE 12
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-780-0002
Provider Business Mailing Address Fax Number:
732-308-0117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 IRON BRIDGE ROAD
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-780-0002
Provider Business Practice Location Address Fax Number:
732-308-0117
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  MA040391 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4058855 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76A38 . This is a "EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: VS120 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3162109 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6159202 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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