Provider Demographics
NPI:1982641775
Name:KERNIZAN, JOSEPH E (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:KERNIZAN
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 1:307 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2739
Mailing Address - Country:US
Mailing Address - Phone:856-686-4300
Mailing Address - Fax:
Practice Address - Street 1:100 TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9011
Practice Address - Country:US
Practice Address - Phone:856-322-3260
Practice Address - Fax:856-322-3061
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46639207P00000X
PAMD040706E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0944602Medicaid
PA599214OtherHIGHMARK BLUE SHIELD
PA0421620000OtherKEYSTONE IBC
PA0011968430002Medicaid
PA1090254OtherKEYSTONE MERCY
PA45279OtherAETNA CONTRACTED
PA45279OtherAETNA CONTRACTED
PA599214JL1Medicare PIN
NJ183003Medicare ID - Type Unspecified