Healthcare Provider Details

I. General information

NPI: 1487576609
Provider Name (Legal Business Name): ZACHARY KUNTZ PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S 54TH ST
PHILADELPHIA PA
19143-1900
US

IV. Provider business mailing address

2049 FERNON ST
PHILADELPHIA PA
19145-1421
US

V. Phone/Fax

Practice location:
  • Phone: 215-748-9000
  • Fax:
Mailing address:
  • Phone: 610-613-5746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP034278
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: