Healthcare Provider Details

I. General information

NPI: 1114374873
Provider Name (Legal Business Name): JACK KURTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 STATE ROUTE 33 STE 4B
NEPTUNE NJ
07753-4860
US

IV. Provider business mailing address

35 BEAVERSON BLVD STE 8C
BRICK NJ
08723-7861
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-8500
  • Fax: 732-262-4319
Mailing address:
  • Phone: 732-451-4202
  • Fax: 732-481-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number25MA10640000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA10640000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: