Individual
KELVIN IMHOMOH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3 INDUSTRIAL WAY E, EATONTOWN, NJ 07724-3318
(732) 544-1557
Mailing address
13 GERARD PL, PARLIN, NJ 08859-2306
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00342800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
I57604306109882
DRIVERS LICENSE
NJ
Enumeration date
05/18/2023
Last updated
05/18/2023
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