MEDICARE: K AND K INDUSTRIES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BN1400X	Nursing Facility Supplies (DME)

General Provider Information

NPI Number	:	1477862340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K AND K INDUSTRIES LLC

Provider Business Mailing Address
First Line	:	100 ASHURST LN
Second Line	:	SUITE 101
City	:	MOUNT HOLLY
State	:	NJ
Zip	:	08060-1202
Country	:	US
Telephone Number	:	609-914-0114
Fax Number	:	609-914-0116

Provider Business Practice Location Address
First Line	:	100 ASHURST LN
Second Line	:	SUITE 101
City	:	MOUNT HOLLY
State	:	NJ
Zip	:	08060-1202
Country	:	US
Telephone Number	:	609-914-0114
Fax Number	:	609-914-0116

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. JOSEPH DYKEMAN
Credential	:
Telephone Number	:	609-914-0114

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	09/27/2010

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