Provider Demographics
NPI:1144201468
Name:KURTA, JEFFREY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:KURTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 N LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4438
Mailing Address - Country:US
Mailing Address - Phone:516-678-0300
Mailing Address - Fax:516-678-9171
Practice Address - Street 1:143 N LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4438
Practice Address - Country:US
Practice Address - Phone:516-678-0300
Practice Address - Fax:516-678-9171
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00564916Medicaid
38A161Medicare ID - Type Unspecified
B80533Medicare UPIN