Provider Demographics
NPI:1790867042
Name:JOHN J. KENNY & WILLIAM GLENN PTRS
Entity Type:Organization
Organization Name:JOHN J. KENNY & WILLIAM GLENN PTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KENNY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-597-7394
Mailing Address - Street 1:1301 RT.72 WEST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3130
Mailing Address - Country:US
Mailing Address - Phone:609-597-7394
Mailing Address - Fax:609-597-6833
Practice Address - Street 1:1301 ROUTE 72 W
Practice Address - Street 2:SUITE 240
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2417
Practice Address - Country:US
Practice Address - Phone:609-597-7394
Practice Address - Fax:609-597-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
826848Medicare ID - Type Unspecified