Provider Demographics
NPI:1972295178
Name:REDZEMATOVIC, KENAN
Entity Type:Individual
Prefix:
First Name:KENAN
Middle Name:
Last Name:REDZEMATOVIC
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 1:211 SAGAMORE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2119
Mailing Address - Country:US
Mailing Address - Phone:917-683-8465
Mailing Address - Fax:
Practice Address - Street 1:211 SAGAMORE LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-2119
Practice Address - Country:US
Practice Address - Phone:917-683-8465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program