Provider Demographics
NPI:1588747299
Name:JB ORTHOPEDICS PA
Entity type:Organization
Organization Name:JB ORTHOPEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:KENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-597-1556
Mailing Address - Street 1:1173 BEACON AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2420
Mailing Address - Country:US
Mailing Address - Phone:609-597-1556
Mailing Address - Fax:609-597-2041
Practice Address - Street 1:1173 BEACON AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2420
Practice Address - Country:US
Practice Address - Phone:609-597-1556
Practice Address - Fax:609-597-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4874910001Medicare NSC
NJ597466Medicare ID - Type UnspecifiedMEDICARE GROUP ID