Healthcare Provider Details

I. General information

NPI: 1760462766
Provider Name (Legal Business Name): IRA M CUTTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 LAUREL RD E UDP #1800
STRATFORD NJ
08084-1354
US

IV. Provider business mailing address

42 E LAUREL RD UDP #1800
STRATFORD NJ
08084-1354
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-6843
  • Fax: 856-566-6419
Mailing address:
  • Phone: 856-566-6843
  • Fax: 856-566-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA04313100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: