Provider Demographics
NPI:1518035625
Name:SWAN, KENNETH GIRVAN JR (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:GIRVAN
Last Name:SWAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 WORLDS FAIR DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1369
Mailing Address - Country:US
Mailing Address - Phone:732-504-3649
Mailing Address - Fax:732-564-9032
Practice Address - Street 1:740 ROUTE 1 N
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2652
Practice Address - Country:US
Practice Address - Phone:732-853-8610
Practice Address - Fax:732-885-3862
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2020-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07516000207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine