Healthcare Provider Details

I. General information

NPI: 1417465741
Provider Name (Legal Business Name): KANE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 SHORE RD
SOMERS POINT NJ
08244-2631
US

IV. Provider business mailing address

223 SHORE RD
SOMERS POINT NJ
08244-2631
US

V. Phone/Fax

Practice location:
  • Phone: 609-705-7546
  • Fax:
Mailing address:
  • Phone: 609-705-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number25MA09419800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA09419800
License Number StateNJ

VIII. Authorized Official

Name: DR. KELLY ROSE KANE
Title or Position: OWNER
Credential: MD
Phone: 215-380-6061