Provider Demographics
NPI:1154556801
Name:NISCH, KENNETH CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHARLES
Last Name:NISCH
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 1:609 JEFFERSON ST.
Mailing Address - Street 2:APT. 3C
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030
Mailing Address - Country:US
Mailing Address - Phone:908-917-7838
Mailing Address - Fax:
Practice Address - Street 1:118 NORTH BEDFORD ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:MT. KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2555
Practice Address - Country:US
Practice Address - Phone:800-362-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244447207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology