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General NPI Number Information
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NPI Number | 1760475776
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Entity Type | Individual
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Provider Name | KENNETH TRUESDALE C.R.N.A.
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Gender | Male
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 1 CLARA MAASS DR
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City | BELLEVILLE
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State | NJ
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Zip | 07109-3550
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Country | US
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Telephone | 973-450-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 67
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City | KENILWORTH
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State | NJ
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Zip | 07033-0067
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Country | US
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Telephone | 201-487-7227
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 453006
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 26N009116700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 26NJ00205400
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License Number State | NJ
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