Provider Demographics
NPI:1033125315
Name:LISS, KENNETH A (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:LISS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:6 INDUSTRIAL WAY W
Mailing Address - Street 2:ST B HYPERTENSION & NEPHROLOGY ASSOC
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2268
Mailing Address - Country:US
Mailing Address - Phone:732-460-1200
Mailing Address - Fax:732-460-1211
Practice Address - Street 1:6 INDUSTRIAL WAY W
Practice Address - Street 2:ST B HYPERTENSION & NEPHROLOGY ASSOC
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2268
Practice Address - Country:US
Practice Address - Phone:732-460-1200
Practice Address - Fax:732-460-1211
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
246ZN0300X
NJ25MB06380300207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No246ZN0300XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7014902Medicaid
G33253Medicare UPIN
NJ7014902Medicaid