Healthcare Provider Details

I. General information

NPI: 1649242181
Provider Name (Legal Business Name): MARC KESSELHAUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 YAWPO AVE SUITE 3
OAKLAND NJ
07436-2714
US

IV. Provider business mailing address

43 YAWPO AVE SUITE 3
OAKLAND NJ
07436-2714
US

V. Phone/Fax

Practice location:
  • Phone: 201-337-9600
  • Fax:
Mailing address:
  • Phone: 201-337-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA55068
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: