MEDICARE: DEBORAH LYNNE KESSOUS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MA73647	NJ

General Provider Information

NPI Number	:	1588860100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH LYNNE KESSOUS M.D.

Provider Business Mailing Address
First Line	:	504 MONMOUTH RD
Second Line	:
City	:	MILLSTONE TOWNSHIP
State	:	NJ
Zip	:	08510-1226
Country	:	US
Telephone Number	:	609-208-0570
Fax Number	:	609-208-0574

Provider Business Practice Location Address
First Line	:	504 MONMOUTH RD
Second Line	:
City	:	MILLSTONE TOWNSHIP
State	:	NJ
Zip	:	08510-1226
Country	:	US
Telephone Number	:	609-208-0570
Fax Number	:	609-208-0574

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	05/02/2013

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