Provider Demographics
NPI:1568436848
Name:FREEDMAN, KENNETH JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JAY
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRIER HILL COURT
Mailing Address - Street 2:D6
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3335
Mailing Address - Country:US
Mailing Address - Phone:732-254-6011
Mailing Address - Fax:732-254-7271
Practice Address - Street 1:BRIER HILL COURT
Practice Address - Street 2:D6
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3335
Practice Address - Country:US
Practice Address - Phone:732-254-6011
Practice Address - Fax:732-254-7271
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ073203Medicare ID - Type Unspecified