Provider Demographics
NPI:1093059198
Name:KENNEDY-HARJES, TRINA
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:KENNEDY-HARJES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6926
Mailing Address - Country:US
Mailing Address - Phone:732-239-6618
Mailing Address - Fax:
Practice Address - Street 1:1418 HOLMES AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6926
Practice Address - Country:US
Practice Address - Phone:732-239-6618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ43ZA00258200227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified