Provider Demographics
NPI:1457078693
Name:DUNN, KEITH DARNELL (CPRS-NJ)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DARNELL
Last Name:DUNN
Suffix:
Gender:M
Credentials:CPRS-NJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 N OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-1825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1409 CANTILLON BLVD
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2023
Practice Address - Country:US
Practice Address - Phone:609-601-8611
Practice Address - Fax:609-601-8610
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJCPRS-50307175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist