Provider Demographics
NPI:1285664854
Name:KANOFF, MARTIN E (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:E
Last Name:KANOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8210
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-8210
Mailing Address - Country:US
Mailing Address - Phone:856-232-0050
Mailing Address - Fax:856-232-0251
Practice Address - Street 1:100 KINGS WAY E
Practice Address - Street 2:STE D4
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2237
Practice Address - Country:US
Practice Address - Phone:856-232-0050
Practice Address - Fax:856-232-0251
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04130200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2330202Medicaid
NJ2330202Medicaid
NJ037040Medicare ID - Type UnspecifiedMEDICARE