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KENILWORTH PRIMARY CARE LLC
NPI 1164793014
Clinic/Center - Primary Care in Kenilworth, NJ

Active since January 24, 2012CLIA 31D2040770 · Waiver
66 S 21ST ST, KENILWORTH, NJ 07033(908) 276-9595(908) 276-6807 Get Directions Write a Review

NPPES record last updated: January 24, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Kenilworth Primary Care Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENILWORTH PRIMARY CARE LLC (NPI 1164793014) is a healthcare organization registered as a primary care in Kenilworth, New Jersey and active in the NPI registry since January 2012. The organization holds a CLIA Waiver certificate valid through May 8, 2028 and lists Bhavani Jeereddy, Sole Member, as its authorized official.

NPPES Registry Identity

NPI1164793014
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameKENILWORTH PRIMARY CARE LLC
Location Address66 S 21ST STKenilworth, NJ 07033-1626
Mailing Address66 S 21st StKenilworth, NJ 07033-1626 · (908) 276-9595 · Fax (908) 276-6807
Phone(908) 276-9595
Fax(908) 276-6807
Organization SubpartNo
Authorized OfficialBhavani JeereddySole Member · (908) 276-9595
Enumeration DateJanuary 24, 2012
✔ NPI 1164793014 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
66 S 21ST ST, Kenilworth, NJ 07033
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 31D2040770

Kenilworth Primary Care · Kenilworth, NJ
Active · expires May 8, 2028
CLIA Number31D2040770
Laboratory TypePhysician Office
Certificate Effective DateMay 9, 2026
Certificate Expiration DateMay 8, 2028
Laboratory DirectorBhavani Jeereddy
Laboratory Phone(908) 276-9595
Laboratory LocationKenilworth Primary Care66 South 21st Street, Kenilworth, NJ 07033
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDREA J FRANK D O P C
Internal Medicine
66 S 21ST ST
KENILWORTH, NJ 07033
Union County (908) 276-4447
DR. BHAVANI JEEREDDY MD
Internal Medicine
66 S 21ST ST
KENILWORTH, NJ 07033
Union County (908) 276-9595
ANDREA J FRANK D O P C
Internal Medicine
66 S 21ST ST
KENILWORTH, NJ 07033
Union County (908) 276-4447

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenilworth Primary Care LLC's NPI number?

The NPI number for Kenilworth Primary Care LLC is 1164793014. It was assigned to this organization in the NPPES registry on January 24, 2012.

Where is Kenilworth Primary Care LLC located?

Kenilworth Primary Care LLC is located at 66 S 21st St, Kenilworth, NJ 07033. The listed phone number is (908) 276-9595.

What is Kenilworth Primary Care LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Kenilworth Primary Care LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 31D2040770) is associated with this NPI, valid through May 8, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kenilworth Primary Care LLC was last updated on January 24, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.