Healthcare Provider Details

I. General information

NPI: 1760528681
Provider Name (Legal Business Name): KINNELON MEDICAL & PEDIATRIC ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 KINNELON RD STE 28
KINNELON NJ
07405-2347
US

IV. Provider business mailing address

170 KINNELON RD STE 28
KINNELON NJ
07405-2347
US

V. Phone/Fax

Practice location:
  • Phone: 973-838-1717
  • Fax: 973-838-1775
Mailing address:
  • Phone: 973-838-1717
  • Fax: 973-838-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA08006300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMA34985
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA43353
License Number StateNJ

VIII. Authorized Official

Name: DR. ABHAY K SUDA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 973-838-1717