Healthcare Provider Details

I. General information

NPI: 1295063410
Provider Name (Legal Business Name): KENNETH ALLEN KAPPY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2009
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HARRISON WAY
MOUNT ARLINGTON NJ
07856-2325
US

IV. Provider business mailing address

9 HARRISON WAY
MT ARLINGTON NJ
07856-2325
US

V. Phone/Fax

Practice location:
  • Phone: 973-601-7562
  • Fax:
Mailing address:
  • Phone: 973-601-7562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMA035937
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: