Provider Demographics
NPI:1043531726
Name:DAFTANI, KENNEDY PALWASHA FAZLI (MD, MHSA)
Entity type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:PALWASHA FAZLI
Last Name:DAFTANI
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Gender:F
Credentials:MD, MHSA
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Mailing Address - Street 1:271 GROVE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1730
Mailing Address - Country:US
Mailing Address - Phone:973-559-3700
Mailing Address - Fax:833-484-1686
Practice Address - Street 1:271 GROVE AVE STE A
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1731
Practice Address - Country:US
Practice Address - Phone:973-239-2600
Practice Address - Fax:973-239-8650
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2023-11-08
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09194600207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine