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General NPI Number Information
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NPI Number | 1821289828
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Entity Type | Organization
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Legal Business Name | KENNETH INDAHL
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 2399 HIGHWAY 34 SUITE A6
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City | MANASQUAN
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State | NJ
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Zip | 08736-1500
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Country | US
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Telephone | 732-528-8223
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Fax | 732-528-7057
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Provider Business Mailing Address
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Address Line | 2399 HIGHWAY 34 SUITE A6
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City | MANASQUAN
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State | NJ
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Zip | 08736-1500
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Country | US
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Telephone | 732-528-8223
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Fax | 732-528-7057
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH INDAHL
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Credential | DPM
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Telephone | 732-528-8223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00100900
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License Number State | NJ
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