Healthcare Provider Details

I. General information

NPI: 1922035575
Provider Name (Legal Business Name): MARC KITROSSER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 MCBRIDE AVE SUITE D105
WOODLAND PARK NJ
07424-2559
US

IV. Provider business mailing address

1031 MCBRIDE AVE SUITE D105
WOODLAND PARK NJ
07424-2559
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-0002
  • Fax: 973-256-3919
Mailing address:
  • Phone: 973-256-0002
  • Fax: 973-256-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD01115
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: