Healthcare Provider Details

I. General information

NPI: 1346971520
Provider Name (Legal Business Name): CORI KUTZIN APN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD
LIVINGSTON NJ
07039-5672
US

IV. Provider business mailing address

20 SHERWOOD RD
LITTLE SILVER NJ
07739-1309
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ01323800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: