Provider Demographics
NPI:1457390361
Name:SEBASTIAN, KENNETH FRANCIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:FRANCIS
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 LAUREL RD E
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1301
Mailing Address - Country:US
Mailing Address - Phone:856-783-6361
Mailing Address - Fax:856-783-0168
Practice Address - Street 1:217 LAUREL RD E
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1301
Practice Address - Country:US
Practice Address - Phone:856-783-6361
Practice Address - Fax:856-783-0168
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00108800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1086502Medicaid
NJT44547Medicare UPIN
NJ1086502Medicaid