Provider Demographics
NPI:1447239850
Name:KULESSA, SIGMUND LEWIS JR (DO)
Entity Type:Individual
Prefix:DR
First Name:SIGMUND
Middle Name:LEWIS
Last Name:KULESSA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-1231
Mailing Address - Country:US
Mailing Address - Phone:732-254-3892
Mailing Address - Fax:732-254-4037
Practice Address - Street 1:123 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-1231
Practice Address - Country:US
Practice Address - Phone:732-254-3892
Practice Address - Fax:732-254-4037
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB24981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ171189Medicaid
NJE06167Medicare UPIN
NJEO6167Medicare UPIN