Healthcare Provider Details

I. General information

NPI: 1619158672
Provider Name (Legal Business Name): IRWIN LAWRENCE KUTASH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 EAST NORTHFIELD RD SUITE 1E
LIVINGSTON NJ
07039
US

IV. Provider business mailing address

340 EAST NORTHFIELD RD SUITE 1E
LIVINGSTON NJ
07039
US

V. Phone/Fax

Practice location:
  • Phone: 201-738-4483
  • Fax:
Mailing address:
  • Phone: 201-738-4483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number983
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: