Provider Demographics
NPI:1750472205
Name:ORDENE, KENNETH W (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:ORDENE
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 1:501 IRON BRIDGE ROAD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-780-0002
Mailing Address - Fax:732-308-0117
Practice Address - Street 1:501 IRON BRIDGE ROAD
Practice Address - Street 2:SUITE 12
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-780-0002
Practice Address - Fax:732-308-0117
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA040391207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
4058855OtherAETNA
76A38OtherEMPIRE
NJVS120OtherOXFORD
NJ3162109Medicaid
6159202OtherCIGNA
NJ026098Medicare ID - Type Unspecified
NJ3162109Medicaid