Provider Demographics
NPI:1851097703
Name:IGLESIAS, KEVIN G
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:IGLESIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-1809
Mailing Address - Country:US
Mailing Address - Phone:201-759-7700
Mailing Address - Fax:
Practice Address - Street 1:646 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1809
Practice Address - Country:US
Practice Address - Phone:201-759-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)