Provider Demographics
NPI:1528089018
Name:HAAS, KENT STEVEN (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:STEVEN
Last Name:HAAS
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 1:127 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1718
Mailing Address - Country:US
Mailing Address - Phone:856-845-0500
Mailing Address - Fax:856-384-8757
Practice Address - Street 1:127 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1718
Practice Address - Country:US
Practice Address - Phone:856-845-0500
Practice Address - Fax:856-384-8757
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032074E208600000X, 2086S0129X
NJ25MA06544900208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA668781OtherHIGHMARK BLUE SHIELD
PA0501778000OtherAMERIHEALTH
NJ713467OtherHORIZON BLUE SHIELD
NJ5508401Medicaid
NJ0481883000OtherAMERIHEALTH
PA0012663940005Medicaid
E83625Medicare UPIN
NJ001376Medicare ID - Type Unspecified
NJ5508401Medicaid