Etienne Kenfack, APN

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

26NJ00905700 Issued in NJ

Practice address

191 Palisade Ave
Jersey City, NJ 07306-1112

Phone

(201) 656-4324

Fax

(201) 656-4019

NPI assigned

Mar 2, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

95.04 of 100Reported as group

Quality

100

Improvement activities

40

Cost

55.16

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pain and Disability Institute, P.C.

  • Pain Medicine Physician
  • Jersey City, NJ
  • NPI 1306924725
  Medicare reassignment NPD
• Ambulatory Pain and Disability Management Center LLC

  • Ambulatory Surgical Clinic/Center
  • Jersey City, NJ
  • NPI 1093311276
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551484800000",
    "number": "1033677679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 CHESTER AVE",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071113142",
            "telephone_number": "862-224-0668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 PALISADE AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073061112",
            "telephone_number": "201-656-4324",
            "fax_number": "201-656-4019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENFACK",
        "first_name": "ETIENNE",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-02",
        "last_updated": "2019-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "26NJ00905700",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NJ",
            "license": "26NJ00905700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kdl19 LLC (Hudson County Health Care)
• Colleen Mary Keegan, MA CF-SLP
• Stephen Kelleher, DMD
• Sarah Beth Kelner, MS-OTR/L, CLT
• Kelsey Munster Therapy LLC
• David Kenigsberg, MD
• Kennedy Rehab & Physical Therapy
• Kirsten Marie Kennedy
• Robert Edward Kennedy, PH.D.
• Kenneth S Chang MD PA

• Primary Care Nurse Practitioner in Jersey City, NJ
• Providers in Jersey City, NJ by specialty
• Primary Care Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.