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General NPI Number Information
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NPI Number | 1831845122
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Entity Type | Individual
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Provider Name | ALEXANDER PATRICK KENNEDY
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Gender | Male
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 3 INDUSTRIAL WAY E
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City | EATONTOWN
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State | NJ
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Zip | 07724-3318
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Country | US
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Telephone | 732-544-1557
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Fax |
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Provider Business Mailing Address
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Address Line | 136 KYLE DR
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City | TINTON FALLS
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State | NJ
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Zip | 07712-7537
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Country | US
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Telephone | 816-830-8776
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00334600
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License Number State | NJ
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