Active NPI
Kelly Anne Pender, LMT
- Massage Therapist
- Jersey City, NJ
National Provider Identifier
1205646015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 18KT01012100
- Practice address
- 30 Provost St
Jersey City, NJ 07302-5866 - Phone
- (551) 689-0763
- NPI assigned
- Jan 13, 2025
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 18KT01012100 | NJ | Primary |
Addresses
Primary practice location
30 Provost St
Jersey City, NJ 07302-5866
Mailing address
556 Ridge St
Newark, NJ 07104-1514
Phone (551) 689-0059
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 |
|---|---|---|---|
| 18KT01012100 | NJ | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736726400000",
"number": "1205646015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "556 RIDGE ST",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071041514",
"telephone_number": "551-689-0059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 PROVOST ST",
"city": "JERSEY CITY",
"state": "NJ",
"postal_code": "073025866",
"telephone_number": "551-689-0763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDER",
"first_name": "KELLY",
"middle_name": "ANNE",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-01-13",
"last_updated": "2025-01-13",
"certification_date": "2025-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NJ",
"license": "18KT01012100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jersey City, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.