Provider Demographics
NPI:1124389473
Name:ROGER KASENDORF, DO, PC
Entity Type:Organization
Organization Name:ROGER KASENDORF, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:KASENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:858-429-6290
Mailing Address - Street 1:9834 GENESEE AVE
Mailing Address - Street 2:SUITE 427
Mailing Address - City:LAJOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-429-6290
Mailing Address - Fax:858-244-0152
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:SUITE 427
Practice Address - City:LAJOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-429-6290
Practice Address - Fax:858-244-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239449208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty