Provider Demographics
NPI:1033149729
Name:KEMENOSH, MATTHEW P (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:P
Last Name:KEMENOSH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:OCEAN CITY HEALTH
Other - Middle Name:
Other - Last Name:AND SPINE CENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:300 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-4008
Mailing Address - Country:US
Mailing Address - Phone:609-399-6000
Mailing Address - Fax:609-399-6565
Practice Address - Street 1:300 3RD ST
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-4008
Practice Address - Country:US
Practice Address - Phone:609-399-6000
Practice Address - Fax:609-399-6565
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00353700111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT90336Medicare ID - Type Unspecified
NJ223580687Medicare UPIN