Provider Demographics
NPI:1841013711
Name:ELEY, KENNETH
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:ELEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PENNANT LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-2730
Mailing Address - Country:US
Mailing Address - Phone:973-704-4303
Mailing Address - Fax:
Practice Address - Street 1:20 PENNANT LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-2730
Practice Address - Country:US
Practice Address - Phone:973-704-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula