1588649768 NPI number — KESSLER ORTHOTIC AND PROSTHETIC INC

Table of content: (NPI 1588649768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588649768 NPI number — KESSLER ORTHOTIC AND PROSTHETIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KESSLER ORTHOTIC AND PROSTHETIC INC
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:
Provider Other Organization Name Type Code:
6
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:
1588649768
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:
11 MICROLAB RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-992-9700
Provider Business Mailing Address Fax Number:
973-533-1015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 MICROLAB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-992-9700
Provider Business Practice Location Address Fax Number:
973-533-1015
Provider Enumeration Date:
12/12/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EPPINGER
Authorized Official First Name:
GUS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR ORTHOTICS PROSTHETICS
Authorized Official Telephone Number:
973-992-9700

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 0074268 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".