Provider Demographics
NPI:1154321891
Name:KURTZER, YITZCHOK BARRY (MD)
Entity Type:Individual
Prefix:MR
First Name:YITZCHOK
Middle Name:BARRY
Last Name:KURTZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BARRY
Other - Middle Name:Y
Other - Last Name:KURTZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1405 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2224
Mailing Address - Country:US
Mailing Address - Phone:570-342-8199
Mailing Address - Fax:570-342-6871
Practice Address - Street 1:1405 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2224
Practice Address - Country:US
Practice Address - Phone:570-342-8199
Practice Address - Fax:570-342-6871
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040950L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB40967Medicare UPIN