Provider Demographics
NPI:1679812630
Name:KPUC, LLC
Entity type:Organization
Organization Name:KPUC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-371-4400
Mailing Address - Street 1:65 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2931
Mailing Address - Country:US
Mailing Address - Phone:732-371-4400
Mailing Address - Fax:
Practice Address - Street 1:65 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2931
Practice Address - Country:US
Practice Address - Phone:732-371-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency MedicineGroup - Single Specialty