Individual
KENNETH BANNERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD FACC
Contact information
Practice address
1310 BROAD ST, BLOOMFIELD, NJ 07003-3009
(973) 338-0800
(973) 338-1140
Mailing address
1310 BROAD ST, BLOOMFIELD, NJ 07003-3009
(973) 338-0800
(973) 338-1140
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
66554
NJ
207RC0000X
Cardiovascular Disease Physician
Primary
66554
NJ
Other
Enumeration date
08/16/2005
Last updated
07/12/2007
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