NPIMap

Organization Active NPI

KMC Eeg Department Group

  • Neurology Physician
  • Lakewood, NJ
National Provider Identifier
1790735017
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
KMC EEG DEPARTMENT GROUP
Practice address
600 River Ave
Lakewood, NJ 08701-5237
Phone
(732) 886-4443
Fax
(732) 886-4659
NPI assigned
May 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Anthony Esposito
Title
Director
Phone
(732) 557-7160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

600 River Ave
Lakewood, NJ 08701-5237

Mailing address

PO Box 6069
Bellmawr, NJ 08099-6069
Phone (732) 557-7160

Other identifiers 1

IdentifierTypeStateIssuer
7136307MedicaidNJ

National Provider Directory

National Provider Directory

Locations

101 Prospect St
Ste 202
Lakewood, NJ 08701
Phone (732) 942-4442

Practitioners & affiliated clinicians

Practitioners 61

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790735017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6069",
            "city": "BELLMAWR",
            "state": "NJ",
            "postal_code": "080996069",
            "telephone_number": "732-557-7160",
            "fax_number": "732-557-7109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 RIVER AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015237",
            "telephone_number": "732-886-4443",
            "fax_number": "732-886-4659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KMC EEG DEPARTMENT GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ESPOSITO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "732-557-7160",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7136307",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.