Basic Information
| Provider Information | |||||||||
| NPI: | 1588791438 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRKPATRICK | ||||||||
| FirstName: | FELIX | ||||||||
| MiddleName: | JAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 TEMPEST LANE | ||||||||
| Address2: | |||||||||
| City: | WILLINGBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080463802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098775208 | ||||||||
| FaxNumber: | 6098773794 | ||||||||
| Practice Location | |||||||||
| Address1: | 817 EAST GATE DRIVE | ||||||||
| Address2: | SUITE 1B | ||||||||
| City: | MT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567781090 | ||||||||
| FaxNumber: | 8567789191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207R00000X | 039833 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3733700 | 05 | NJ | MEDICAID |