Provider Demographics
NPI:1871559005
Name:KAIDEN, JEFFREY SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SAMUEL
Last Name:KAIDEN
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 698
Mailing Address - Street 2:300 FAIRVIEW AVENUE
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-666-4014
Mailing Address - Fax:201-666-4754
Practice Address - Street 1:300 FAIRVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-666-4014
Practice Address - Fax:201-666-4754
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03386500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
222103828OtherBCBS
NJ438103Medicaid
180011364OtherRR MEDICARE
180011364OtherRR MEDICARE
NJ158073BK0Medicare ID - Type Unspecified