Provider Demographics
NPI:1619155066
Name:DR. EVAN KELNER, DPM, PA
Entity Type:Organization
Organization Name:DR. EVAN KELNER, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-988-0070
Mailing Address - Street 1:1398 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3543
Mailing Address - Country:US
Mailing Address - Phone:732-988-0070
Mailing Address - Fax:732-988-0250
Practice Address - Street 1:1398 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3543
Practice Address - Country:US
Practice Address - Phone:732-988-0070
Practice Address - Fax:732-988-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00197400332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4070680001Medicare NSC
NJ123824X7UMedicare PIN