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General NPI Number Information
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NPI Number | 1245481399
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Entity Type | Individual
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Provider Name | KEITH KANIK M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 4 FRIENDSHIP LN
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1287
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Country | US
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Telephone | 732-222-0109
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Fax |
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Provider Business Mailing Address
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Address Line | 4 FRIENDSHIP LN
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1287
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Country | US
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Telephone | 732-222-0109
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | ME 67850
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 25MA09671700
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License Number State | NJ
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