Active NPI
Kelnerperiollc
- Periodontics
- Clark, NJ
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 22DI00899900
- Legal business name
- KELNERPERIOLLC
- Practice address
- 67 Walnut Ave Ste 307
Clark, NJ 07066-1687 - Phone
- (732) 587-6740
- Fax
- (732) 587-6741
- NPI assigned
- May 27, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Richard Michael Kelner, DMD
- Title
- Partner Owner
- Phone
- (732) 587-6740
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 22DI00899900 | NJ | Primary |
Addresses
Primary practice location
67 Walnut Ave Ste 307
Clark, NJ 07066-1687
Mailing address
67 Walnut Ave Ste 307
Clark, NJ 07066-1687
Phone (732) 587-6740
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22DI00899900 | Other | NJ | NJ DENTAL LICENSE |
National Provider Directory
National Provider Directory- Tax ID family
- Kelner Periodontics
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Dentist
- Clark, NJ
- NPI 1396096855
Locations
67 Walnut Ave
Ste 307
Clark, NJ 07066
Phone (732) 587-6740
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Periodontics
- Clark, NJ
- NPI 1477513539
-
- Periodontics
- Clark, NJ
- NPI 1407084239
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432684800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1432684800000",
"number": "1205215050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "67 WALNUT AVE STE 307",
"city": "CLARK",
"state": "NJ",
"postal_code": "070661687",
"telephone_number": "732-587-6740",
"fax_number": "732-587-6741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "67 WALNUT AVE STE 307",
"city": "CLARK",
"state": "NJ",
"postal_code": "070661687",
"telephone_number": "732-587-6740",
"fax_number": "732-587-6741"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KELNERPERIOLLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-05-27",
"last_updated": "2015-05-27",
"status": "A",
"authorized_official_last_name": "KELNER",
"authorized_official_first_name": "RICHARD",
"authorized_official_middle_name": "MICHAEL",
"authorized_official_title_or_position": "PARTNER OWNER",
"authorized_official_telephone_number": "732-587-6740",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DMD"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Periodontics",
"state": "NJ",
"license": "22DI00899900",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NJ DENTAL LICENSE",
"identifier": "22DI00899900",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.