Individual
KEVIN INNELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
29 E 29TH ST, BAYONNE, NJ 07002-4654
(201) 858-6596
(201) 603-6684
Mailing address
108 VILLAGE RD, GREEN VILLAGE, NJ 07935-3032
(908) 477-7783
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/15/2024
Last updated
04/15/2024
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