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General NPI Number Information
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NPI Number | 1043279979
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Entity Type | Individual
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Provider Name | KEN EDWARD MISHLER MD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 02/02/2010
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Provider Practice Location Address
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Address Line | 968 HAMBURG TPKE
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City | WAYNE
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State | NJ
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Zip | 07470-3225
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Country | US
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Telephone | 973-696-0300
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Fax | 973-696-0465
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Provider Business Mailing Address
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Address Line | 968 HAMBURG TPKE
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City | WAYNE
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State | NJ
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Zip | 07470-3225
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Country | US
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Telephone | 973-696-0300
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Fax | 973-696-0465
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA03246200
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License Number State | NJ
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