Individual provider Active NPI

Kenneth Kurt Konegen, DDS

  • General Practice Dentistry
  • Cranford, NJ
National Provider Identifier
1932294147
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D1009038 Issued in NJ
Practice address
24 North Ave West
Cranford, NJ 07016
Phone
(908) 276-2385
Fax
(908) 276-2891
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D1009038 NJ Primary

Addresses

Primary practice location

24 North Ave West
Cranford, NJ 07016

Mailing address

24 North Ave West
Cranford, NJ 07016
Phone (908) 276-2385

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160331000319 NJ Order and Referring Only - DentistPractitioner - Dentist 4284931510

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D1009038NJMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932294147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 NORTH AVE WEST",
            "city": "CRANFORD",
            "state": "NJ",
            "postal_code": "07016",
            "telephone_number": "908-276-2385",
            "fax_number": "908-276-2891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 NORTH AVE WEST",
            "city": "CRANFORD",
            "state": "NJ",
            "postal_code": "07016",
            "telephone_number": "908-276-2385",
            "fax_number": "908-276-2891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONEGEN",
        "first_name": "KENNETH",
        "middle_name": "KURT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "D1009038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cranford, NJ

Sources for this page

Verify at the official NPI Registry.