Provider Demographics
NPI:1649341942
Name:EMERY, KEVIN JUDE (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JUDE
Last Name:EMERY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2609
Mailing Address - Country:US
Mailing Address - Phone:201-447-3707
Mailing Address - Fax:201-447-0320
Practice Address - Street 1:310 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2609
Practice Address - Country:US
Practice Address - Phone:201-447-3707
Practice Address - Fax:201-447-0320
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00312100111NS0005X
NYX0044501111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0076805OtherAETNA PROVIDER IDENTIFICA
NJ222854051OtherTAX IDENTIFICATION NUMBER
NJP643830OtherOXFORD PROVIDER NUMBER
NJ607510OtherUNITED HEALTHCARE PROVIDE
NJEM453483Medicare ID - Type Unspecified
NJP643830OtherOXFORD PROVIDER NUMBER