=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821256470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDOCRINOLOGY ASSOCIATES OF CENTRAL NEW JERSEY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2008
-----------------------------------------------------
Last Update Date | 09/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 IRON BRIDGE RD SUITE 12
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-780-0002
-----------------------------------------------------
Fax | 732-308-0117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 IRON BRIDGE RD SUITE 12
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-780-0002
-----------------------------------------------------
Fax | 732-308-0117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | KENNETH W ORDENE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 732-780-0002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------