Provider Demographics
NPI:1083111843
Name:VENESCAR, KARL JERSON
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:JERSON
Last Name:VENESCAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:MC AFEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07428-0932
Mailing Address - Country:US
Mailing Address - Phone:973-440-0802
Mailing Address - Fax:973-965-9559
Practice Address - Street 1:40 ROUTE 94
Practice Address - Street 2:
Practice Address - City:MCAFEE
Practice Address - State:NJ
Practice Address - Zip Code:07428
Practice Address - Country:US
Practice Address - Phone:973-440-0802
Practice Address - Fax:973-965-9559
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251B00000XAgenciesCase Management