Provider Demographics
NPI:1548421787
Name:MARC KITROSSER DPM PA
Entity Type:Organization
Organization Name:MARC KITROSSER DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:KITROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-256-0002
Mailing Address - Street 1:1031 MCBRIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:973-256-0002
Mailing Address - Fax:973-256-3919
Practice Address - Street 1:1031 MCBRIDE AVE
Practice Address - Street 2:
Practice Address - City:WEST PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07424
Practice Address - Country:US
Practice Address - Phone:973-256-0002
Practice Address - Fax:973-256-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD001115213E00000X
NJ25MD002932213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3050807Medicaid
NJT32215Medicare UPIN
KI432962Medicare PIN