Provider Demographics
NPI:1013998756
Name:HERMAN, KENNETH L (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 W RED BANK AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1630
Mailing Address - Country:US
Mailing Address - Phone:856-853-0900
Mailing Address - Fax:856-853-5838
Practice Address - Street 1:17 W RED BANK AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-853-0900
Practice Address - Fax:856-853-5838
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB0479100207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8107509004OtherCIGNA
NJ0693784000OtherAMERIHEALTH
NJ24034OtherAETNA US HEALTHCARE
NJ751636OtherBLUE SHIELD
NJ751636OtherBLUE SHIELD
NJ8107509004OtherCIGNA