Provider Demographics
NPI:1295766988
Name:KENNY, JAMES JOSEPH (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOSEPH
Last Name:KENNY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CLEVELAND CIR
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2002
Mailing Address - Country:US
Mailing Address - Phone:609-683-4747
Mailing Address - Fax:609-683-3837
Practice Address - Street 1:239 PROSPECT PLAINS RD STE B101
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-3704
Practice Address - Country:US
Practice Address - Phone:609-395-9955
Practice Address - Fax:609-395-1605
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00308000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ057154TAPMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID