Healthcare Provider Details

I. General information

NPI: 1902606833
Provider Name (Legal Business Name): BSD MEDICAL PRACTICE II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 VAUXHALL RD STE 100-11
UNION NJ
07083-3409
US

IV. Provider business mailing address

1620 VAUXHALL RD STE 100-11
UNION NJ
07083-3409
US

V. Phone/Fax

Practice location:
  • Phone: 908-882-2025
  • Fax: 718-387-6429
Mailing address:
  • Phone: 908-882-2025
  • Fax: 718-387-6429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY MICHAEL KANE
Title or Position: MD/CEO
Credential:
Phone: 845-202-9787