Provider Demographics
NPI:1558378976
Name:SNYDER, KENNETH ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROBERT
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:331 ROUTE 206
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4781
Mailing Address - Country:US
Mailing Address - Phone:908-685-2528
Mailing Address - Fax:732-463-6065
Practice Address - Street 1:331 ROUTE 206
Practice Address - Street 2:SUITE 2B
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4781
Practice Address - Country:US
Practice Address - Phone:908-685-2528
Practice Address - Fax:732-463-6065
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06058400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG637969Medicare UPIN
NJ893759Medicare PIN