Individual
KENNETH CHARLES PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
523 FELLOWSHIP RD STE 275, MOUNT LAUREL, NJ 08054-3445
(856) 235-7666
Mailing address
20 ANONA DR, UPPER SADDLE RIVER, NJ 07458-1103
(203) 609-3601
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
25MA04603300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13463603300
LAUREL EVALUATIONS, P.A.
NJ
Enumeration date
07/14/2017
Last updated
07/14/2017
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