Provider Demographics
NPI:1194747964
Name:NINI, KEVIN T (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:NINI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:409 JOYCE KILMER AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3363
Mailing Address - Country:US
Mailing Address - Phone:732-418-0709
Mailing Address - Fax:732-418-0747
Practice Address - Street 1:409 JOYCE KILMER AVE STE 210
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-418-0709
Practice Address - Fax:732-418-0747
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA057354208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA057354OtherLICENSE
NJE93316Medicare UPIN