Healthcare Provider Details

I. General information

NPI: 1851333827
Provider Name (Legal Business Name): PAUL A KESSELMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W HENRIETTA AVE
OCEANSIDE NY
11572-5054
US

IV. Provider business mailing address

224 W HENRIETTA AVE
OCEANSIDE NY
11572-5054
US

V. Phone/Fax

Practice location:
  • Phone: 516-457-6959
  • Fax: 347-382-9388
Mailing address:
  • Phone: 718-338-7878
  • Fax: 718-338-7879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number003251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: