Provider Demographics
NPI:1720181688
Name:KERN, JOHN CREAHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CREAHAN
Last Name:KERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 NOTCH HILL DRIVE
Mailing Address - Street 2:P.O. BOX 1576
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-7176
Mailing Address - Country:US
Mailing Address - Phone:973-994-4549
Mailing Address - Fax:
Practice Address - Street 1:24 NOTCH HILL DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-6126
Practice Address - Country:US
Practice Address - Phone:973-994-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0540341744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA81742Medicare UPIN