Provider Demographics
NPI:1346388931
Name:KETSELMAN, ALEXANDER (CMT)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:KETSELMAN
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 HUNTLEY WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-5566
Mailing Address - Country:US
Mailing Address - Phone:908-704-1856
Mailing Address - Fax:
Practice Address - Street 1:37 HUNTLEY WAY
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-5566
Practice Address - Country:US
Practice Address - Phone:908-704-1856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00031500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist