Kenilworth Primary Care LLC
NPI #1164793014 in Kenilworth, New Jersey
Provider Information
- NPI Number
- 1164793014
- Entity Type
- Organization
- Organization Name
- Kenilworth Primary Care LLC
- Primary Specialty
- Clinic/Center - Primary Care
- Enumeration Date
- Jan 24, 2012
- Last Updated
- Jan 24, 2012
Practice Location
- Address
- 66 S 21ST ST
- City
- Kenilworth
- State
- New Jersey
- ZIP Code
- 07033-1626
- Phone
- (908) 276-9595
Authorized Official
- Name
- DR. BHAVANI JEEREDDY, M.D.
- Title
- SOLE MEMBER
- Phone
- (908) 276-9595
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Primary Care — Primary Care |
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