Provider Demographics
NPI:1104528033
Name:MEKKAWY, KEVIN L (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:MEKKAWY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JUSTIN LN
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2576
Mailing Address - Country:US
Mailing Address - Phone:201-410-8592
Mailing Address - Fax:
Practice Address - Street 1:15 JUSTIN LN
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2576
Practice Address - Country:US
Practice Address - Phone:201-410-8592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program