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

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

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 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:

1548310774

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

08/22/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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 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

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

• 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" .

• 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".