Provider Demographics
NPI:1265491880
Name:WENGERTER, KURT RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:RICHARD
Last Name:WENGERTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 ROCKWOOD PL
Mailing Address - Street 2:SUITE 330
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4957
Mailing Address - Country:US
Mailing Address - Phone:201-408-5195
Mailing Address - Fax:201-408-2485
Practice Address - Street 1:25 ROCKWOOD PL
Practice Address - Street 2:SUITE 330
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4957
Practice Address - Country:US
Practice Address - Phone:201-408-5195
Practice Address - Fax:201-408-2485
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06395000208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ020034631OtherRAILROAD MEDICARE ID #
NY01026099Medicaid
NJ6984100Medicaid
NJ779693N1QMedicare PIN
NJ6984100Medicaid