Provider Demographics
NPI:1629017017
Name:JANOWSKI, KENNETH JAMES (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JAMES
Last Name:JANOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 COUNTRY MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5205
Mailing Address - Country:US
Mailing Address - Phone:908-850-6806
Mailing Address - Fax:908-850-6815
Practice Address - Street 1:12 COUNTRY MEADOW RD
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-5205
Practice Address - Country:US
Practice Address - Phone:908-850-6806
Practice Address - Fax:908-850-6815
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ59720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ758830SMLOtherMEDICARE - CORP ID
NJ6858601Medicaid
NJJA758830Medicare ID - Type Unspecified
NJ6858601Medicaid