Center for Preventative Medicine of New Jersey

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA04002500 Issued in NJ

Legal business name

CENTER FOR PREVENTATIVE MEDICINE OF NEW JERSEY

Practice address

5 Stanley Rd
South Orange, NJ 07079-2721

Phone

(973) 762-6077

NPI assigned

Mar 14, 2007

Last updated

Apr 16, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kevin D Holder, MDNPI 1063543254

Title

Owner

Phone

(973) 762-6077

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin D Holder, MD

  • Family Medicine Physician
  • South Orange, NJ
  • NPI 1063543254
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366070400000",
    "number": "1083747299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 STANLEY RD",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792721",
            "telephone_number": "973-762-6077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 STANLEY RD",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792721",
            "telephone_number": "973-762-6077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR PREVENTATIVE MEDICINE OF NEW JERSEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2013-04-16",
        "status": "A",
        "authorized_official_last_name": "HOLDER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-762-6077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA04662500",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA04002500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William A Carri
• Arienne Carrington
• Kelly Carroll
• Liam Cassidy, DPT
• Center for Gynecologic Oncology & Women's Health Inc.
• James Edward Chenitz, D.M.D.
• Children's Aid and Family Services, Inc.
• Chiro-Row Health Consortium, LLC
• Youn Hee Cho, NP
• Chosen Path Wellness

• Internal Medicine Physician in South Orange, NJ
• Providers in South Orange, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.