Provider Demographics
NPI:1417900614
Name:SCHULNER, KENNETH DAVID (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DAVID
Last Name:SCHULNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SUNSET RD
Mailing Address - Street 2:STE 2B
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1126
Mailing Address - Country:US
Mailing Address - Phone:609-871-4487
Mailing Address - Fax:609-871-4491
Practice Address - Street 1:220 SUNSET RD
Practice Address - Street 2:STE 2B
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1126
Practice Address - Country:US
Practice Address - Phone:609-871-4487
Practice Address - Fax:609-871-4491
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04240900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54225Medicare UPIN