Provider Demographics
NPI:1689390403
Name:DANIELES, KEVIN (APN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:DANIELES
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 ROUTE 88 W STE 250
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3044
Mailing Address - Country:US
Mailing Address - Phone:732-840-8880
Mailing Address - Fax:732-840-3939
Practice Address - Street 1:1608 ROUTE 88 W STE 250
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3044
Practice Address - Country:US
Practice Address - Phone:732-840-8880
Practice Address - Fax:732-840-3939
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01381600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner