Healthcare Provider Details

I. General information

NPI: 1801249214
Provider Name (Legal Business Name): PETER KUZMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W PROSPECT ST STE 2
EAST BRUNSWICK NJ
08816-2161
US

IV. Provider business mailing address

21 WALTER AVE
HIGHLAND PARK NJ
08904-1709
US

V. Phone/Fax

Practice location:
  • Phone: 732-254-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00273400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: