Healthcare Provider Details

I. General information

NPI: 1205539681
Provider Name (Legal Business Name): TONY PIERRE KERBAJ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 BOULEVARD
KENILWORTH NJ
07033-1657
US

IV. Provider business mailing address

528 BOULEVARD
KENILWORTH NJ
07033-1657
US

V. Phone/Fax

Practice location:
  • Phone: 908-276-6624
  • Fax:
Mailing address:
  • Phone: 908-276-6624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number25MD00392100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00392100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: