Provider Demographics
NPI:1285622191
Name:KAIN, EILEEN (NP)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:KAIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ROUTE 73 N
Mailing Address - Street 2:40 LAKE CENTER DRIVE STE 201A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3425
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0346
Practice Address - Street 1:120 CARNIE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4520
Practice Address - Country:US
Practice Address - Phone:856-424-8004
Practice Address - Fax:856-424-8007
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05097500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS66485Medicare UPIN
NJ085893R63Medicare ID - Type Unspecified