Provider Demographics
NPI:1508011248
Name:PAUL KESSELMAN DPM
Entity Type:Organization
Organization Name:PAUL KESSELMAN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-338-7878
Mailing Address - Street 1:224 WEST HENRIETTA AVENUE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572
Mailing Address - Country:US
Mailing Address - Phone:718-338-7878
Mailing Address - Fax:718-338-7879
Practice Address - Street 1:1203 AVENUE J
Practice Address - Street 2:SUITE 3A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3603
Practice Address - Country:US
Practice Address - Phone:718-338-7878
Practice Address - Fax:718-338-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003251213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty