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General NPI Number Information
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NPI Number | 1609957976
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Entity Type | Individual
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Provider Name | THOMAS ANDREW KEDERSHA M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 25 MULE RD SUITE B 2
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City | TOMS RIVER
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State | NJ
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Zip | 08755-5035
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Country | US
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Telephone | 732-349-5453
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Fax | 732-681-3426
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Provider Business Mailing Address
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Address Line | 3403 W HURLEY POND RD
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City | WALL
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State | NJ
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Zip | 07719-9606
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Country | US
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Telephone | 732-681-0805
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Fax | 732-681-3426
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA03781900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 25MA03781900
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA03781900
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License Number State | NJ
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