Provider Demographics
NPI:1497755532
Name:WHITEHOUSE STATION FAMILY MEDICINE, P.A.
Entity Type:Organization
Organization Name:WHITEHOUSE STATION FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-534-2249
Mailing Address - Street 1:263 MAIN ST
Mailing Address - Street 2:BOX 128
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-3620
Mailing Address - Country:US
Mailing Address - Phone:908-534-2249
Mailing Address - Fax:908-534-6634
Practice Address - Street 1:263 MAIN ST
Practice Address - Street 2:BOX 128
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889-3620
Practice Address - Country:US
Practice Address - Phone:908-534-2249
Practice Address - Fax:908-534-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ526855Medicare UPIN
NJ526855Medicare ID - Type Unspecified