Healthcare Provider Details

I. General information

NPI: 1942668124
Provider Name (Legal Business Name): NEPTUNE AMBULATORY ANESTHESIA & PAIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3613 ROUTE 33
NEPTUNE NJ
07753-3101
US

IV. Provider business mailing address

PO BOX 188
LITTLE SILVER NJ
07739-0188
US

V. Phone/Fax

Practice location:
  • Phone: 732-264-1127
  • Fax: 732-264-0670
Mailing address:
  • Phone: 732-264-1127
  • Fax: 732-264-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THEODORE E KUTZIN
Title or Position: MEMBER
Credential: M.D.
Phone: 732-264-1127