Individual
ETIENNE KENFACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APN
Contact information
Practice address
191 PALISADE AVE, JERSEY CITY, NJ 07306-1112
(201) 656-4324
(201) 656-4019
Mailing address
42 CHESTER AVE, IRVINGTON, NJ 07111-3142
(862) 224-0668
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
26NJ00905700
NJ
363LP2300X
Primary Care Nurse Practitioner
Primary
26NJ00905700
NJ
Other
Enumeration date
03/02/2019
Last updated
03/02/2019
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