Provider Demographics
NPI:1467529792
Name:KRACHMAN, JOEL ETHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ETHAN
Last Name:KRACHMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 BETHEL RD
Mailing Address - Street 2:POINT COMMONS SUITE E
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-926-3330
Mailing Address - Fax:609-926-9033
Practice Address - Street 1:408 BETHEL RD
Practice Address - Street 2:SUITE E
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2172
Practice Address - Country:US
Practice Address - Phone:609-926-3330
Practice Address - Fax:609-926-9033
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB51598207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ723836OtherAMERIHEALTH
NJ4233970OtherAETNA
NJ5166209Medicaid
NJ5166209Medicaid
NJ723836OtherAMERIHEALTH