Healthcare Provider Details

I. General information

NPI: 1366968703
Provider Name (Legal Business Name): JOSHUA KARL KUTINSKY PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 WALNUT ST STE 1500
PHILADELPHIA PA
19102-3611
US

IV. Provider business mailing address

1810 N 71ST ST
PHILADELPHIA PA
19151-2306
US

V. Phone/Fax

Practice location:
  • Phone: 215-735-2505
  • Fax:
Mailing address:
  • Phone: 610-742-4936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberPS017496
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: