Active NPI
Kenneth W. Willis, M.D.
- Psychiatry Physician
- Skillman, NJ
National Provider Identifier
1356431696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 25MA04067300
- Practice address
- 168 Tamarack Cir
Skillman, NJ 08558-2021 - Phone
- (609) 497-1560
- NPI assigned
- Oct 16, 2006
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 25MA04067300 | NJ | Primary |
Addresses
Primary practice location
168 Tamarack Cir
Skillman, NJ 08558-2021
Mailing address
168 Tamarack Cir
Skillman, NJ 08558-2021
Phone (609) 497-1560
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3939901 | Medicaid | NJ |
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 |
|---|---|---|---|
| 25MA04067300 | NJ | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356431696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "168 TAMARACK CIR",
"city": "SKILLMAN",
"state": "NJ",
"postal_code": "085582021",
"telephone_number": "609-497-1560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "168 TAMARACK CIR",
"city": "SKILLMAN",
"state": "NJ",
"postal_code": "085582021",
"telephone_number": "609-497-1560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "KENNETH",
"middle_name": "W.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NJ",
"license": "25MA04067300",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3939901",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Skillman, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.