Provider Demographics
NPI:1780603829
Name:KINGSTON MEDICAL PRACTICE
Entity type:Organization
Organization Name:KINGSTON MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOLIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-667-3300
Mailing Address - Street 1:1046 DELL DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2911
Mailing Address - Country:US
Mailing Address - Phone:856-495-9564
Mailing Address - Fax:856-667-4365
Practice Address - Street 1:1046 DELL DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2911
Practice Address - Country:US
Practice Address - Phone:856-495-9564
Practice Address - Fax:856-667-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12118207Q00000X
PAMD007509E207Q00000X
NJMA19911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D98824Medicare UPIN
M0023578L7FMedicare ID - Type Unspecified