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NPI Code Detail

MEDICARE: KENNETH TRUESDALE C.R.N.A.

MEDICARE: KENNETH TRUESDALE C.R.N.A.
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
1207L00000XAnesthesiology Physician453006NY
2367500000XCertified Registered Nurse Anesthetist26N009116700NJ
3367500000XCertified Registered Nurse Anesthetist26NJ00205400NJ

General Provider Information

NPI Number : 1760475776
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH TRUESDALE C.R.N.A.
Provider Business Mailing Address
First Line : PO BOX 67
Second Line :
City : KENILWORTH
State : NJ
Zip : 07033-0067
Country : US
Telephone Number : 201-487-7227
Fax Number :
Provider Business Practice Location Address
First Line : 1 CLARA MAASS DR
Second Line :
City : BELLEVILLE
State : NJ
Zip : 07109-3550
Country : US
Telephone Number : 973-450-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 11/18/2025

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