Provider Demographics
NPI:1770855405
Name:THE COUNCIL ON AGING OF MARTIN COUNTY INC
Entity Type:Organization
Organization Name:THE COUNCIL ON AGING OF MARTIN COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTO OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KANESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-223-7803
Mailing Address - Street 1:900 SE SALERNO RD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6405
Mailing Address - Country:US
Mailing Address - Phone:772-223-7803
Mailing Address - Fax:772-463-0091
Practice Address - Street 1:900 SE SALERNO RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6405
Practice Address - Country:US
Practice Address - Phone:772-223-7803
Practice Address - Fax:772-463-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty