=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659667079
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTHONY J KAISER MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2011
-----------------------------------------------------
Last Update Date | 06/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 N FULLERTON AVE
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07042-3412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-783-0133
-----------------------------------------------------
Fax | 732-872-4465
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 85 BAYSIDE DR
-----------------------------------------------------
City | ATLANTIC HIGHLANDS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07716-1734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-872-4402
-----------------------------------------------------
Fax | 732-872-4465
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANTHONY J KAISER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 732-872-4402
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 25MAO2425200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------