Provider Demographics
NPI:1649242181
Name:KESSELHAUT, MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:KESSELHAUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 YAWPO AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2714
Mailing Address - Country:US
Mailing Address - Phone:201-337-9600
Mailing Address - Fax:
Practice Address - Street 1:43 YAWPO AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2714
Practice Address - Country:US
Practice Address - Phone:201-337-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE60170Medicare UPIN
NJ631261WC0Medicare PIN