Active NPI
Keith Kanik, M.D.
- Rheumatology Physician
- West Long Branch, NJ
National Provider Identifier
1245481399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- 25MA09671700
- Practice address
- 4 Friendship LN
West Long Branch, NJ 07764-1287 - Phone
- (732) 222-0109
- NPI assigned
- Oct 7, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | ME 67850 | FL | |
| Rheumatology Physician | 207RR0500X | 25MA09671700 | NJ | Primary |
Addresses
Primary practice location
4 Friendship LN
West Long Branch, NJ 07764-1287
Mailing address
4 Friendship LN
West Long Branch, NJ 07764-1287
Phone (732) 222-0109
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 67850 | FL | MD | Rheumatology Physician |
| 25MA09671700 | NJ | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538524800000",
"number": "1245481399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 FRIENDSHIP LN",
"city": "WEST LONG BRANCH",
"state": "NJ",
"postal_code": "077641287",
"telephone_number": "732-222-0109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 FRIENDSHIP LN",
"city": "WEST LONG BRANCH",
"state": "NJ",
"postal_code": "077641287",
"telephone_number": "732-222-0109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANIK",
"first_name": "KEITH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-07",
"last_updated": "2018-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "FL",
"license": "ME 67850",
"primary": false
},
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "NJ",
"license": "25MA09671700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Long Branch, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.