Active NPI
Kelly P Knowles, MD
- Pediatrics Physician
- Millburn, NJ
National Provider Identifier
1003895798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA06821100
- Practice address
- 159 Millburn Ave
Ste 1
Millburn, NJ 07041-1849 - Phone
- (973) 912-0155
- Fax
- (973) 912-8714
- NPI assigned
- Jan 11, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25MA06821100 | NJ | Primary |
| Pediatric Adolescent Medicine Physician | 2080A0000X | 25MA06821100 | NJ |
Addresses
Primary practice location
159 Millburn Ave
Ste 1
Millburn, NJ 07041-1849
Mailing address
159 Millburn Ave
Ste 1
Millburn, NJ 07041-1849
Phone (973) 912-0155
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010068211NJ01 | Other | NJ | ANTHEM HEALTH PIN |
| 2113135000 | Other | NJ | AMERIHEALTH HMO PIN |
| 1K7604 | Other | NJ | HEALTHNET PIN |
| 956005 | Other | NJ | AMERIHEALTH PPO GRP PIN |
| P2075112 | Other | NJ | OXFORD PIN |
| 606914 | Other | NJ | PHCS GRP ID |
| K4810 | Other | NJ | BCBS MANAGED CARE PIN |
| 0501095 | Other | NJ | AETNA HMO GRP ID |
| 1997280 | Other | NJ | UNITED HEALTH CARE PIN |
| 223285437 | Other | NJ | BEECH ST GRP ID |
| 7182328007 | Other | NJ | CIGNA PIN |
| 4102R | Other | NJ | WELL CHOICE PIN |
| 001427892 | Other | NJ | HIGH MARK PA BLUE SHIELD |
| 223285437 | Other | NJ | HCPCS GRP ID |
| 2532962 | Other | NJ | AETNA HMO PIN |
Other names 1
- Kelly Petrison
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA06821100 | NJ | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Millburn Pediatrics PA | Adolescent Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Adolescent Medicine Physician
- Millburn, NJ
- NPI 1932231719
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357084800000",
"number": "1003895798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "159 MILLBURN AVE",
"address_2": "STE 1",
"city": "MILLBURN",
"state": "NJ",
"postal_code": "070411849",
"telephone_number": "973-912-0155",
"fax_number": "973-912-8714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "159 MILLBURN AVE",
"address_2": "STE 1",
"city": "MILLBURN",
"state": "NJ",
"postal_code": "070411849",
"telephone_number": "973-912-0155",
"fax_number": "973-912-8714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNOWLES",
"first_name": "KELLY",
"middle_name": "P",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-11",
"last_updated": "2013-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA06821100",
"primary": true
},
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "NJ",
"license": "25MA06821100",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM HEALTH PIN",
"identifier": "010068211NJ01",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH HMO PIN",
"identifier": "2113135000",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET PIN",
"identifier": "1K7604",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH PPO GRP PIN",
"identifier": "956005",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD PIN",
"identifier": "P2075112",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS GRP ID",
"identifier": "606914",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MANAGED CARE PIN",
"identifier": "K4810",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO GRP ID",
"identifier": "0501095",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE PIN",
"identifier": "1997280",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEECH ST GRP ID",
"identifier": "223285437",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA PIN",
"identifier": "7182328007",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELL CHOICE PIN",
"identifier": "4102R",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGH MARK PA BLUE SHIELD",
"identifier": "001427892",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HCPCS GRP ID",
"identifier": "223285437",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO PIN",
"identifier": "2532962",
"state": "NJ"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "PETRISON",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Millburn, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.