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NPI Code Detail

MEDICARE: DR. EDNA MORAA KENNEDY

MEDICARE: DR. EDNA MORAA KENNEDY
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
1183500000XPharmacist28RJ08036NJ
2183500000XPharmacist28RI03988000NJ

General Provider Information

NPI Number : 1992316574
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDNA MORAA KENNEDY
Provider Business Mailing Address
First Line : 1633 SPRINGFIELD AVE
Second Line :
City : MAPLEWOOD
State : NJ
Zip : 07040-2922
Country : US
Telephone Number : 973-761-7391
Fax Number : 973-761-7036
Provider Business Practice Location Address
First Line : 1633 SPRINGFIELD AVE
Second Line :
City : MAPLEWOOD
State : NJ
Zip : 07040-2922
Country : US
Telephone Number : 973-761-7391
Fax Number : 973-761-7036
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2020
Last Update Date : 08/16/2020

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Directions to “ DR. EDNA MORAA KENNEDY ” Practice Location

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