Provider Demographics
NPI:1891724076
Name:KUNKLE, HERBERT L (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:L
Last Name:KUNKLE
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 1:3600 ROUTE 66 FL 3
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2605
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:201-751-1680
Practice Address - Street 1:1173 BEACON AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2420
Practice Address - Country:US
Practice Address - Phone:609-250-4104
Practice Address - Fax:609-978-4860
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024230E207X00000X
NJ25MA04816000207X00000X
NY270411207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001282404Medicaid
NY03658835Medicaid
NYJ400105059Medicare PIN
PA001282404Medicaid