Healthcare Provider Details

I. General information

NPI: 1043405509
Provider Name (Legal Business Name): JOHN FRANCIS KUSTRUP JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RIVER KNOLL DRIVE
TITUSVILLE NJ
08650-1305
US

IV. Provider business mailing address

9 RIVER KNOLL DRIVE
TITUSVILLE NJ
08650-1305
US

V. Phone/Fax

Practice location:
  • Phone: 609-882-1104
  • Fax:
Mailing address:
  • Phone: 609-882-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA01832900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: