Healthcare Provider Details

I. General information

NPI: 1124040316
Provider Name (Legal Business Name): JEREMIAH KURZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/27/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 FOREST AVE
PARAMUS NJ
07652
US

IV. Provider business mailing address

277 FOREST AVENUE
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-986-1881
  • Fax: 201-986-1871
Mailing address:
  • Phone: 201-267-0909
  • Fax: 201-986-0241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number227241
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA08153600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02777686
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: