1912161225 NPI number — KESLER PODIATRY P C

Table of content: (NPI 1912161225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912161225 NPI number — KESLER PODIATRY P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KESLER PODIATRY P C
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:
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:
1912161225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 HAMBURG TPKE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07470-2048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-835-8350
Provider Business Mailing Address Fax Number:
973-835-8340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 HAMBURG TPKE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470-2048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-835-8350
Provider Business Practice Location Address Fax Number:
973-835-8340
Provider Enumeration Date:
07/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KESLER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-835-8350

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  25MD00286800 , 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: 146916 . This is a "MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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