Healthcare Provider Details

I. General information

NPI: 1215891551
Provider Name (Legal Business Name): CHARITY KUTTO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MAIN ST
TOMS RIVER NJ
08753-7443
US

IV. Provider business mailing address

505 MAIN ST
TOMS RIVER NJ
08753-7443
US

V. Phone/Fax

Practice location:
  • Phone: 732-272-0127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15452800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: