Provider Demographics
NPI:1265464515
Name:HEALEY, KEVIN M (DPM)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:HEALEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011
Mailing Address - Country:US
Mailing Address - Phone:973-340-8970
Mailing Address - Fax:973-340-8632
Practice Address - Street 1:152 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011
Practice Address - Country:US
Practice Address - Phone:973-340-8970
Practice Address - Fax:973-340-8632
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01387213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3227308Medicaid
434136Medicare ID - Type Unspecified
NJ3227308Medicaid