Healthcare Provider Details

I. General information

NPI: 1437154085
Provider Name (Legal Business Name): CHARLES MICHAEL KURTZER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E NORTHFIELD RD STE 1B
LIVINGSTON NJ
07039-4800
US

IV. Provider business mailing address

315 E NORTHFIELD RD STE 1B
LIVINGSTON NJ
07039-4800
US

V. Phone/Fax

Practice location:
  • Phone: 973-992-0002
  • Fax: 973-740-1413
Mailing address:
  • Phone: 973-992-0002
  • Fax: 973-740-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD001379
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: