Provider Demographics
NPI:1730769019
Name:KELLERMAN, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KELLERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2114
Mailing Address - Country:US
Mailing Address - Phone:209-768-3006
Mailing Address - Fax:
Practice Address - Street 1:50 JOYCE KILMER AVE
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-8045
Practice Address - Country:US
Practice Address - Phone:848-445-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program