Provider Demographics
NPI:1568506152
Name:KEARNY MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:KEARNY MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-955-0660
Mailing Address - Street 1:728 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3048
Mailing Address - Country:US
Mailing Address - Phone:201-955-0660
Mailing Address - Fax:201-955-0663
Practice Address - Street 1:728 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3048
Practice Address - Country:US
Practice Address - Phone:201-955-0660
Practice Address - Fax:201-955-0663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA073494174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA073494OtherLICENSE
NJ8773602Medicaid
NJBF7795757OtherDEA
NJ056490RQ0Medicare ID - Type Unspecified