Provider Demographics
NPI:1497766463
Name:KEMP, DENISE (CRNA, MS)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:KEMP
Suffix:
Gender:F
Credentials:CRNA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CANTERBURY WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-3869
Mailing Address - Country:US
Mailing Address - Phone:732-751-1940
Mailing Address - Fax:
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-972-7867
Practice Address - Fax:973-972-2357
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N010690300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089019Medicare ID - Type Unspecified
NJ086019A01Medicare PIN
NJ086019DBHMedicare PIN