Provider Demographics
NPI:1336320274
Name:TOSS, KEVIN DALE (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DALE
Last Name:TOSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 CLIFTON AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-777-2536
Mailing Address - Fax:973-777-6963
Practice Address - Street 1:1135 CLIFTON AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-777-2536
Practice Address - Fax:973-777-6963
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38MC00627900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084374TJZMedicare PIN
NJU80705Medicare UPIN