Healthcare Provider Details

I. General information

NPI: 1639432743
Provider Name (Legal Business Name): JUSTINE E KURTZNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUSTINE E BERTOLO NP

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON ST
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

ELM AND CARLTON ST
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2300
  • Fax: 716-845-3423
Mailing address:
  • Phone: 716-845-2300
  • Fax: 716-845-3423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: