Provider Demographics
NPI:1902813843
Name:KANOFF, JACK M (DO)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:M
Last Name:KANOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:107 VINE ST
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037
Mailing Address - Country:US
Mailing Address - Phone:609-561-7666
Mailing Address - Fax:609-567-8347
Practice Address - Street 1:107 VINE ST
Practice Address - Street 2:SOUTH JERSEY CHEST DISEASES
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037
Practice Address - Country:US
Practice Address - Phone:609-561-7666
Practice Address - Fax:609-567-8347
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB51473207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ23054OtherAETNA
NJ110132972OtherRR MEDICARE
NJ2330105Medicaid
NJ532646OtherIBC
1006475OtherMERCY
NJ290002755OtherRR MEDICARE
NJJ27185OtherHEALTHNET
NJP369523OtherDXFDRD
NJJ27185OtherHEALTHNET
NJP369523OtherDXFDRD
D71202Medicare UPIN