Provider Demographics
NPI:1356323851
Name:KIESOW, CHRISTOPHER JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:KIESOW
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:24 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2353
Mailing Address - Country:US
Mailing Address - Phone:609-261-0248
Mailing Address - Fax:
Practice Address - Street 1:3458 NEELY RD
Practice Address - Street 2:305TH MEDICAL GROUP
Practice Address - City:MC GUIRE AFB
Practice Address - State:NJ
Practice Address - Zip Code:08641-5312
Practice Address - Country:US
Practice Address - Phone:609-754-9146
Practice Address - Fax:609-754-9662
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY21766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant