Healthcare Provider Details

I. General information

NPI: 1063518801
Provider Name (Legal Business Name): JANE KUTSOWSKY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S MAIN ST UNIT 4
MARLBORO NJ
07746-2477
US

IV. Provider business mailing address

130 S MAIN ST UNIT 4
MARLBORO NJ
07746-2477
US

V. Phone/Fax

Practice location:
  • Phone: 732-252-6555
  • Fax: 732-312-5249
Mailing address:
  • Phone: 732-252-6555
  • Fax: 732-312-5249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV 006545
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00584200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: