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NPI Code Detail

MEDICARE: MR. KEVIN JOHN MCCAFFERTY CRNA

MEDICARE: MR. KEVIN JOHN MCCAFFERTY CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist26NR04704300NJ

General Provider Information

NPI Number : 1164495743
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN JOHN MCCAFFERTY CRNA
Provider Business Mailing Address
First Line : 102 S MARION AVE
Second Line :
City : VENTNOR CITY
State : NJ
Zip : 08406-3030
Country : US
Telephone Number : 609-822-5745
Fax Number : 609-822-5749
Provider Business Practice Location Address
First Line : 3205 FIRE RD
Second Line :
City : EGG HARBOR TOWNSHIP
State : NJ
Zip : 08234-5884
Country : US
Telephone Number : 609-407-1113
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 07/08/2007

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