Provider Demographics
NPI:1447371927
Name:KRISTOPHER KORSAKOFF MD LLC
Entity type:Organization
Organization Name:KRISTOPHER KORSAKOFF MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KORSAKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-864-6029
Mailing Address - Street 1:P.O BOX 949
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462
Mailing Address - Country:US
Mailing Address - Phone:973-864-6029
Mailing Address - Fax:973-209-1895
Practice Address - Street 1:212 STATE ROUTE 94
Practice Address - Street 2:SUITE 1A
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462
Practice Address - Country:US
Practice Address - Phone:973-864-6029
Practice Address - Fax:973-209-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72514207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty