Provider Demographics
NPI:1467491944
Name:GARRETT, KENNETH (MD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:GARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 RATZER RD
Mailing Address - Street 2:STE. #7
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7702
Mailing Address - Country:US
Mailing Address - Phone:973-694-2222
Mailing Address - Fax:973-694-7664
Practice Address - Street 1:330 RATZER RD
Practice Address - Street 2:STE. #7
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7702
Practice Address - Country:US
Practice Address - Phone:973-694-2222
Practice Address - Fax:973-694-7664
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03618800207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0957402Medicaid
NJ0071977000OtherAMERIHEALTH
NJ023472BHHMedicare ID - Type Unspecified
NJ0957402Medicaid