Provider Demographics
NPI:1396713988
Name:KESSLER, EDMUND (MD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:
Last Name:KESSLER
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:PO BOX 9007
Mailing Address - Street 2:ATT: PHYSICIAN BILLING
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-9007
Mailing Address - Country:US
Mailing Address - Phone:516-255-1616
Mailing Address - Fax:516-255-4672
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5312
Practice Address - Country:US
Practice Address - Phone:516-489-9000
Practice Address - Fax:516-498-9005
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197699174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01554925Medicaid
NY158461Medicare ID - Type UnspecifiedMDICARE #
NY01554925Medicaid