Provider Demographics
NPI:1457833055
Name:KASHKIN, KENNETH BLAIR
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:BLAIR
Last Name:KASHKIN
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 1:8 HEMLOCK TER
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1248
Mailing Address - Country:US
Mailing Address - Phone:973-919-8340
Mailing Address - Fax:
Practice Address - Street 1:8 HEMLOCK TER
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1248
Practice Address - Country:US
Practice Address - Phone:973-919-8340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT25832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine