Healthcare Provider Details

I. General information

NPI: 1538275458
Provider Name (Legal Business Name): ELYSE BETH KERNIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELYSE BETH WEISS

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ROUTE 168 STE C3
TURNERSVILLE NJ
08012-3206
US

IV. Provider business mailing address

900 ROUTE 168 STE C3
TURNERSVILLE NJ
08012-3206
US

V. Phone/Fax

Practice location:
  • Phone: 856-374-0430
  • Fax: 856-374-0048
Mailing address:
  • Phone: 856-374-0430
  • Fax: 856-374-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2004005141
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101014848
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB08794500
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number250241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: