Provider Demographics
NPI:1821076472
Name:KESELMAN, IRA G (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:G
Last Name:KESELMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10 INDUSTRIAL WAY E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3332
Mailing Address - Country:US
Mailing Address - Phone:732-963-9091
Mailing Address - Fax:732-963-9092
Practice Address - Street 1:10 INDUSTRIAL WAY E STE 101
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3332
Practice Address - Country:US
Practice Address - Phone:732-963-9091
Practice Address - Fax:732-963-9092
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2021-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06197100208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6513301Medicaid
G05225Medicare UPIN
NJ727724AGVMedicare PIN
NJ3400011960Medicare PIN