Provider Demographics
NPI:1841393725
Name:KERZNER, JACK J (EDD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:J
Last Name:KERZNER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MECHANIC ST
Mailing Address - Street 2:KERZNER ASSOCIATES
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-4021
Mailing Address - Country:US
Mailing Address - Phone:508-543-2133
Mailing Address - Fax:508-543-2133
Practice Address - Street 1:30 MECHANIC ST
Practice Address - Street 2:KERZNER ASSOCIATES
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-4021
Practice Address - Country:US
Practice Address - Phone:508-543-2133
Practice Address - Fax:508-543-2133
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3265103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03314Medicare ID - Type Unspecified