Provider Demographics
NPI:1346644689
Name:REY, KENITH BENAIAH
Entity Type:Individual
Prefix:
First Name:KENITH BENAIAH
Middle Name:
Last Name:REY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 CEDARWOOD LN APT I
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8493
Mailing Address - Country:US
Mailing Address - Phone:910-538-8094
Mailing Address - Fax:
Practice Address - Street 1:4306 CEDARWOOD LN APT I
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8493
Practice Address - Country:US
Practice Address - Phone:910-538-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management