Healthcare Provider Details

I. General information

NPI: 1558378976
Provider Name (Legal Business Name): KENNETH ROBERT SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 ROUTE 206 SUITE 2B
HILLSBOROUGH NJ
08844-4781
US

IV. Provider business mailing address

331 ROUTE 206 SUITE 2B
HILLSBOROUGH NJ
08844-4781
US

V. Phone/Fax

Practice location:
  • Phone: 908-685-2528
  • Fax: 732-463-6065
Mailing address:
  • Phone: 908-685-2528
  • Fax: 732-463-6065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06058400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: