Organization
CANDLELIGHT MEDICAL
Active
Other names
Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACKIE KINNEY (DIRECTOR)
(973) 353-8813
Entity
Organization
Contact information
Practice address
195 CENTRAL AVE, NEWARK, NJ 07103-3921
(973) 353-8813
(973) 353-8815
Mailing address
195 CENTRAL AVE, NEWARK, NJ 07103-3921
(973) 353-8813
(973) 353-8815
Taxonomy
Speciality
Code
Description
License number
State
170100000X
Ph.D. Medical Genetics
Primary
25MA02378100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0079871
—
NJ
05
—
8848254
—
NJ
Enumeration date
01/09/2007
Last updated
08/22/2020
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