Provider Demographics
NPI:1093901522
Name:KENNETH JANOWSKI, DO LLC
Entity Type:Organization
Organization Name:KENNETH JANOWSKI, DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-850-6806
Mailing Address - Street 1:12 COUNTRY MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5205
Mailing Address - Country:US
Mailing Address - Phone:908-850-6806
Mailing Address - Fax:908-850-6815
Practice Address - Street 1:12 COUNTRY MEADOW RD
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-5205
Practice Address - Country:US
Practice Address - Phone:908-850-6806
Practice Address - Fax:908-850-6815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05972000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6858601Medicaid
NJF76073Medicare UPIN
NJ758830SMLMedicare PIN