Healthcare Provider Details

I. General information

NPI: 1376631028
Provider Name (Legal Business Name): SHELDON P KERNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLZ COOPER UNIVERSITY RADIOLOGY
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

3 COOPER PLZ SUITE 502
CAMDEN NJ
08103-1438
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2382
  • Fax: 856-365-0472
Mailing address:
  • Phone: 856-968-7433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMB25021
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: