Provider Demographics
NPI:1154505782
Name:RICHARD S. KRESLOFF MD PA
Entity Type:Organization
Organization Name:RICHARD S. KRESLOFF MD PA
Other - Org Name:DRS. KRESLOFF AND YOUNG OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD PA
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KRESLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-854-4242
Mailing Address - Street 1:900 HADDON AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2101
Mailing Address - Country:US
Mailing Address - Phone:856-854-4242
Mailing Address - Fax:856-854-3585
Practice Address - Street 1:900 HADDON AVE
Practice Address - Street 2:STE 102
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-2101
Practice Address - Country:US
Practice Address - Phone:856-854-4242
Practice Address - Fax:856-854-3585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD S. KRESLOFF MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-18
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2994500Medicaid
NJ2994500Medicaid