Provider Demographics
NPI:1538275458
Name:KERNIS, ELYSE BETH (DO)
Entity type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:BETH
Last Name:KERNIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:BETH
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:900 ROUTE 168 STE C3
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3206
Mailing Address - Country:US
Mailing Address - Phone:856-374-0430
Mailing Address - Fax:856-374-0048
Practice Address - Street 1:900 ROUTE 168 STE C3
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3206
Practice Address - Country:US
Practice Address - Phone:856-374-0430
Practice Address - Fax:856-374-0048
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004005141207Q00000X
MI5101014848207Q00000X
NJ25MB08794500207Q00000X
NY250241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209350701Medicaid
34174016OtherBCBS
E28D162BMedicare ID - Type Unspecified
H18789Medicare UPIN