MEDICARE: DR. KENNETH JAMES DAVIS MD

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
1	208000000X	Pediatrics Physician	25MA04177300	NJ

General Provider Information

NPI Number	:	1285650226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH JAMES DAVIS MD

Provider Business Mailing Address
First Line	:	701 NEWARK AVE
Second Line	:	SUITE 212
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-3550
Country	:	US
Telephone Number	:	908-354-9500
Fax Number	:	908-354-9077

Provider Business Practice Location Address
First Line	:	701 NEWARK AVE
Second Line	:	SUITE 212
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-3550
Country	:	US
Telephone Number	:	908-354-9500
Fax Number	:	908-354-9077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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