Healthcare Provider Details

I. General information

NPI: 1881688166
Provider Name (Legal Business Name): KENNETH REMSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 STATE RT 23 FLOOR 2
RIVERDALE NJ
07457-1625
US

IV. Provider business mailing address

51 STATE RT 23 FLOOR 2
RIVERDALE NJ
07457-1625
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-1220
  • Fax: 973-831-0029
Mailing address:
  • Phone: 973-831-1220
  • Fax: 973-831-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberMA43991
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMA43991
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: