Healthcare Provider Details

I. General information

NPI: 1427062876
Provider Name (Legal Business Name): MARIANNE KUTZA PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 TREMONT AVE
EAST ORANGE NJ
07018-1023
US

IV. Provider business mailing address

30 STONEWALL DR
EDISON NJ
08820-2950
US

V. Phone/Fax

Practice location:
  • Phone: 973-676-1000
  • Fax: 973-395-7082
Mailing address:
  • Phone: 732-321-6920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001665-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: