Provider Demographics
NPI:1164514857
Name:KRESLOFF, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:KRESLOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 HADDON AVE
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06843500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8937206Medicaid
NJH22102Medicare UPIN
NJ051833CJHMedicare ID - Type Unspecified