Provider Demographics
NPI:1760535769
Name:KESSELMAN, JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:KESSELMAN
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 1:41 FREDONIA RD
Mailing Address - Street 2:
Mailing Address - City:FREDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-5203
Mailing Address - Country:US
Mailing Address - Phone:973-383-7689
Mailing Address - Fax:973-383-2401
Practice Address - Street 1:41 FREDONIA RD
Practice Address - Street 2:
Practice Address - City:FREDON
Practice Address - State:NJ
Practice Address - Zip Code:07860-5203
Practice Address - Country:US
Practice Address - Phone:973-383-7689
Practice Address - Fax:973-383-2401
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA24905207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB17550Medicare ID - Type Unspecified