Provider Information for 1811545627
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Mr. FENNEL EDWARD KPOLIE LSW
Sex: Male
NPI: 1811545627
Last Updated: 2022-05-31
Certification Date: 2022-05-31
Certification Date: 2022-05-31
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1811545627 | ||||||||||||
| Enumeration Date | 2019-08-27 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4512 KIRKWOOD HWY STE 300 WILMINGTON, DE 19808-5129 United States Phone: 302-623-7515 | Fax: | ||||||||||||
| Primary Practice Address | 1239 PARKWAY AVE STE 102 EWING, NJ 08628-3000 United States Phone: 609-394-3010 | Fax:609-394-3010 | ||||||||||||
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