Healthcare Provider Details

I. General information

NPI: 1326181389
Provider Name (Legal Business Name): DR. BRUCE KERN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PERRINEVILLE RD
MONROE TOWNSHIP NJ
08831-4923
US

IV. Provider business mailing address

253 STONEHILL RD
FREEHOLD NJ
07728-8517
US

V. Phone/Fax

Practice location:
  • Phone: 609-409-9700
  • Fax: 609-409-9797
Mailing address:
  • Phone: 732-462-1917
  • Fax: 718-377-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number42509
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: