Provider Demographics
NPI:1144226093
Name:KRESGE, JOHN E (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:KRESGE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-8512
Mailing Address - Country:US
Mailing Address - Phone:610-530-1891
Mailing Address - Fax:610-530-0844
Practice Address - Street 1:285 DAVIDSON AVE STE 204
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4153
Practice Address - Country:US
Practice Address - Phone:732-271-1400
Practice Address - Fax:732-271-3544
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-324043-L163W00000X
PA048901367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1337989OtherHIGHMARK
PA1337989OtherFIRST PRIORITY
PA11453892OtherCAQH
PA0018603100007Medicaid
PA2030781000OtherIBC
PA50026714OtherCAPITAL ADVANTAGE
PA77537OtherGEISINGER
PA7312259OtherAETNA
PA1544464OtherGATEWAY
PA1337989OtherFIRST PRIORITY
PA0018603100007Medicaid
PA1544464OtherGATEWAY
PA7312259OtherAETNA