1548310774 NPI number — THE DR MARTIN JAY KESSLER MEDICAL SERVICES LLC

Table of content: (NPI 1548310774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548310774 NPI number — THE DR MARTIN JAY KESSLER MEDICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DR MARTIN JAY KESSLER MEDICAL SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DELAWARE VALLEY PRIMARY CAR AND OCCUPATIONAL MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548310774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
234 W LANDIS AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08360-8109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-696-0669
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 W LANDIS AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360-8109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-696-0669
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KESSLER
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
856-696-0669

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25MA06177300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0022654000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1001812 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19827 . This is a "UNIVERSITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: F11051 . This is a "FIRST OPTION" identifier . This identifiers is of the category "OTHER".
  • Identifier: FIRST HEALTH . This is a "1040578" identifier . This identifiers is of the category "OTHER".
  • Identifier: UNITED HEALTHCARE . This is a "89990" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6447601 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8223340 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132049 . This is a "HORIZON BC BS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2657461 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0K7286 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 36924 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: JP141 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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