Healthcare Provider Details

I. General information

NPI: 1447234117
Provider Name (Legal Business Name): JAMES KIRSZROT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FAIRVIEW AVE
WESTWOOD NJ
07675-1749
US

IV. Provider business mailing address

11915 ATLANTIC AVE
RICHMOND HILL NY
11418-3216
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-4014
  • Fax:
Mailing address:
  • Phone: 718-805-0700
  • Fax: 718-805-5621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number226463
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number25MA08774700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: