Healthcare Provider Details

I. General information

NPI: 1942255443
Provider Name (Legal Business Name): MARTHA JEAN KECK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CEDAR CREST VILLAGE DR
POMPTON PLAINS NJ
07444-2100
US

IV. Provider business mailing address

5525 RESEARCH PARK DRIVE 4TH FLOOR
BALTIMORE MD
21228-4664
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-3540
  • Fax: 973-831-3503
Mailing address:
  • Phone: 973-831-3540
  • Fax: 973-831-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNR49634
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: