Provider Demographics
NPI:1669046439
Name:KENA, PRINCE (APN, C)
Entity type:Individual
Prefix:
First Name:PRINCE
Middle Name:
Last Name:KENA
Suffix:
Gender:M
Credentials:APN, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ALLISON DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4474
Mailing Address - Country:US
Mailing Address - Phone:973-204-2811
Mailing Address - Fax:
Practice Address - Street 1:16 ALLISON DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4474
Practice Address - Country:US
Practice Address - Phone:973-204-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01144200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health