Provider Demographics
NPI:1003330069
Name:KDUTT LLC
Entity Type:Organization
Organization Name:KDUTT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KOMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-979-4682
Mailing Address - Street 1:28 BEACON CREST DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2937
Mailing Address - Country:US
Mailing Address - Phone:732-979-4682
Mailing Address - Fax:
Practice Address - Street 1:233 MOUNT AIRY RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2338
Practice Address - Country:US
Practice Address - Phone:732-979-4682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5167103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty