Healthcare Provider Details

I. General information

NPI: 1649274424
Provider Name (Legal Business Name): KENNETH L FRANK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 ANDREA RD
UNION NJ
07083-6428
US

IV. Provider business mailing address

2702 ANDREA RD
UNION NJ
07083-6428
US

V. Phone/Fax

Practice location:
  • Phone: 908-810-9390
  • Fax:
Mailing address:
  • Phone: 908-810-9390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00141600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: