Provider Demographics
NPI:1770856197
Name:KINNELON MEDICAL & WELLNESS ASSOCIATES LLC
Entity Type:Organization
Organization Name:KINNELON MEDICAL & WELLNESS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-838-6252
Mailing Address - Street 1:300 KAKEOUT ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2548
Mailing Address - Country:US
Mailing Address - Phone:973-838-6252
Mailing Address - Fax:973-838-4159
Practice Address - Street 1:300 KAKEOUT RD
Practice Address - Street 2:SUITE C
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2548
Practice Address - Country:US
Practice Address - Phone:973-838-6252
Practice Address - Fax:973-838-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty