Provider Demographics
NPI:1457883928
Name:KWENYAN AND ASSOCIATES
Entity Type:Organization
Organization Name:KWENYAN AND ASSOCIATES
Other - Org Name:KWENYAN PROFESSIONAL HEALTH SERV
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO: ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH
Authorized Official - Phone:609-284-5822
Mailing Address - Street 1:200 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822
Mailing Address - Country:US
Mailing Address - Phone:908-237-3826
Mailing Address - Fax:908-237-3829
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1625
Practice Address - Country:US
Practice Address - Phone:908-237-3826
Practice Address - Fax:908-237-3829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KWENYAN PROFESSIONAL HEALTH SERV
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ100800204261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100800204Medicaid