Provider Demographics
NPI:1043279979
Name:MISHLER, KEN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:EDWARD
Last Name:MISHLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3225
Mailing Address - Country:US
Mailing Address - Phone:973-696-0300
Mailing Address - Fax:973-696-0465
Practice Address - Street 1:968 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3225
Practice Address - Country:US
Practice Address - Phone:973-696-0300
Practice Address - Fax:973-696-0465
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03246200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1206800Medicaid
NJ1206800Medicaid
C52567Medicare UPIN