Healthcare Provider Details

I. General information

NPI: 1457440729
Provider Name (Legal Business Name): DOUGLAS A HUTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 CRANBURY RD STE 1A
EAST BRUNSWICK NJ
08816
US

IV. Provider business mailing address

593 CRANBURY RD STE 1A
EAST BRUNSWICK NJ
08816
US

V. Phone/Fax

Practice location:
  • Phone: 732-613-8880
  • Fax: 732-613-0077
Mailing address:
  • Phone: 732-613-8880
  • Fax: 732-613-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA04602900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA046029
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA04602900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: