Basic Information
| Provider Information | |||||||||
| NPI: | 1467648626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TROLENE | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MMS, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 W MAIN ST | ||||||||
| Address2: | STE 267 | ||||||||
| City: | FREEHOLD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077282537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6099219001 | ||||||||
| FaxNumber: | 6099219055 | ||||||||
| Practice Location | |||||||||
| Address1: | 713 EXECUTIVE DR | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085401529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6099219001 | ||||||||
| FaxNumber: | 6099219055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2007 | ||||||||
| LastUpdateDate: | 07/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | MA053067 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 202316651 | 01 | NJ | TAX ID | OTHER |