Provider Demographics
NPI:1962447144
Name:KYE CO INTERNAL & REHABILITATIVE MEDICINE, PA
Entity Type:Organization
Organization Name:KYE CO INTERNAL & REHABILITATIVE MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-616-7117
Mailing Address - Street 1:100 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1940
Mailing Address - Country:US
Mailing Address - Phone:973-616-7117
Mailing Address - Fax:973-616-7338
Practice Address - Street 1:100 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1940
Practice Address - Country:US
Practice Address - Phone:973-616-7117
Practice Address - Fax:973-616-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB64114207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP2032183OtherOXFORD
NJKC05C94510OtherEMPIRE BC/BS
NJ110214633OtherUNITED HEALTHCARE RAILROA
NJ=========OtherHORIZON BC/BS
NJKC05C94510OtherEMPIRE BC/BS