Healthcare Provider Details

I. General information

NPI: 1891481636
Provider Name (Legal Business Name): DAVID ERIC KERSEN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

10 NOE AVE
MADISON NJ
07940-2834
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2941
  • Fax:
Mailing address:
  • Phone: 973-975-2843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: