Provider Demographics
NPI:1326427329
Name:KAISER FITNESS AND MEDISPA LLC
Entity Type:Organization
Organization Name:KAISER FITNESS AND MEDISPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-758-8251
Mailing Address - Street 1:555 SHREWSBURY AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4165
Mailing Address - Country:US
Mailing Address - Phone:732-758-8251
Mailing Address - Fax:732-758-8250
Practice Address - Street 1:555 SHREWSBURY AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4165
Practice Address - Country:US
Practice Address - Phone:732-758-8251
Practice Address - Fax:732-758-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty