Healthcare Provider Details

I. General information

NPI: 1023647641
Provider Name (Legal Business Name): KEVIN EDWARD PEIFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MADISON AVENUE, 1ST FLOOR
MT. HOLLY NJ
08060
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 609-914-6000
  • Fax: 609-914-6296
Mailing address:
  • Phone: 609-914-6000
  • Fax: 609-914-6296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA12619900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: