Provider Demographics
NPI:1942421839
Name:DR KENNETH FRANK
Entity Type:Organization
Organization Name:DR KENNETH FRANK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-810-9390
Mailing Address - Street 1:2702 ANDREA RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6428
Mailing Address - Country:US
Mailing Address - Phone:908-810-9390
Mailing Address - Fax:
Practice Address - Street 1:111 MULBERRY ST
Practice Address - Street 2:SUITE 1R
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-4008
Practice Address - Country:US
Practice Address - Phone:908-810-9390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00141600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00185429OtherRAILROAD MEDICARE
NJ8383201Medicaid
NJ043281Medicare PIN
NJ4707610001Medicare NSC