MEDICARE: KINNELON MEDICAL & PEDIATRIC ASSOCIATES, PA

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MA34985	NJ
2	208000000X	Pediatrics Physician	MA43353	NJ
3	207Q00000X	Family Medicine Physician	25MA08006300	NJ

General Provider Information

NPI Number	:	1760528681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINNELON MEDICAL & PEDIATRIC ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	170 KINNELON RD STE 28
Second Line	:
City	:	KINNELON
State	:	NJ
Zip	:	07405-2347
Country	:	US
Telephone Number	:	973-838-1717
Fax Number	:	973-838-1775

Provider Business Practice Location Address
First Line	:	170 KINNELON RD STE 28
Second Line	:
City	:	KINNELON
State	:	NJ
Zip	:	07405-2347
Country	:	US
Telephone Number	:	973-838-1717
Fax Number	:	973-838-1775

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ABHAY K SUDA
Credential	:	M.D.
Telephone Number	:	973-838-1717

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	09/11/2025

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