Active NPI
Kenneth Fernandez
- Occupational Therapy Assistant
- Lincoln Park, NJ
National Provider Identifier
1063877207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 46TA09114900
- Practice address
- 209 Comly Rd
M13
Lincoln Park, NJ 07035 - Phone
- (973) 572-2940
- NPI assigned
- Dec 15, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 46TA09114900 | NJ | Primary |
Addresses
Primary practice location
209 Comly Rd
M13
Lincoln Park, NJ 07035
Mailing address
209 Comly Rd
M13
Lincoln Park, NJ 07035
Phone (973) 572-2940
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46TA09114900 | NJ | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450137600000",
"number": "1063877207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 COMLY RD",
"address_2": "M13",
"city": "LINCOLN PARK",
"state": "NJ",
"postal_code": "07035",
"telephone_number": "973-572-2940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 COMLY RD",
"address_2": "M13",
"city": "LINCOLN PARK",
"state": "NJ",
"postal_code": "07035",
"telephone_number": "973-572-2940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDEZ",
"first_name": "KENNETH",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-12-15",
"last_updated": "2015-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NJ",
"license": "46TA09114900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincoln Park, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.