Provider Demographics
NPI:1922035575
Name:KITROSSER, MARC (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:KITROSSER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 MCBRIDE AVE
Mailing Address - Street 2:SUITE D105
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2559
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:SUITE D105
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2559
Practice Address - Country:US
Practice Address - Phone:973-256-0002
Practice Address - Fax:973-256-3919
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01115213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3050807Medicaid
NJT32215Medicare UPIN
NJKI432962Medicare ID - Type Unspecified
NJ3050807Medicaid