Healthcare Provider Details

I. General information

NPI: 1083619860
Provider Name (Legal Business Name): ANTHONY CULTRARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 ARK RD STE 102
MOUNT LAUREL NJ
08054-3100
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL 4
TARRYTOWN NY
10591-5187
US

V. Phone/Fax

Practice location:
  • Phone: 856-576-5743
  • Fax: 856-519-5435
Mailing address:
  • Phone: 914-333-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA07615000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: