Healthcare Provider Details

I. General information

NPI: 1316740525
Provider Name (Legal Business Name): PHILLIP DAVID KUMPF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 LANGDON ST
SOMERSET KY
42503-2750
US

IV. Provider business mailing address

1516 CHALET DR
CHERRY HILL NJ
08003-3018
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-5093
  • Fax: 606-451-5087
Mailing address:
  • Phone: 856-448-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: