Provider Demographics
NPI:1598196719
Name:KWENYAN AND ASSOCIATES
Entity Type:Organization
Organization Name:KWENYAN AND ASSOCIATES
Other - Org Name:KWENYAN PROFESSIONAL HEALTH SERVICES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:609-403-8740
Mailing Address - Street 1:860 LOWER FERRY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3525
Mailing Address - Country:US
Mailing Address - Phone:609-403-8740
Mailing Address - Fax:609-403-8740
Practice Address - Street 1:860 LOWER FERRY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3525
Practice Address - Country:US
Practice Address - Phone:609-403-8740
Practice Address - Fax:609-403-8740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KWENYAN PROFESSIONAL HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ100800104261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1111Medicaid