Basic Information
| Provider Information | |||||||||
| NPI: | 1659385615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINDSFATHER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | KENNETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2 CAPITAL WAY | ||||||||
| Address2: | STE 220 | ||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093030747 | ||||||||
| FaxNumber: | 6093030771 | ||||||||
| Practice Location | |||||||||
| Address1: | 408 BELLEVUE AVE | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086184502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093965800 | ||||||||
| FaxNumber: | 6093965528 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MA56656 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1096898 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 1462388 | 01 | NJ | UNITED HC/RAILROAD MC | OTHER | F17206 | 01 | NJ | HNET | OTHER | 0056735000 | 01 | NJ | KEYSTONE | OTHER | 222369868 | 01 | NJ | HORIZON BC/BS OF NJ | OTHER | 765518 | 01 | NJ | AETNA | OTHER | 1523708 | 01 | NJ | UMWA | OTHER | 7273100 | 05 | NJ | MEDICAID | 0056735000 | 01 | NJ | AMERIHEALTH | OTHER | F17206 | 01 | NJ | GHN | OTHER |