Provider Demographics
NPI:1346397981
Name:TUTNAUER, PHILLIP (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:TUTNAUER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 QUAKERBRIDGE RD
Mailing Address - Street 2:RWJ FITNESS AND WELLNESS CENTER
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1658
Mailing Address - Country:US
Mailing Address - Phone:609-587-0400
Mailing Address - Fax:609-587-4923
Practice Address - Street 1:3100 QUAKERBRIDGE RD
Practice Address - Street 2:RWJ FITNESS AND WELLNESS CENTER
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08619
Practice Address - Country:US
Practice Address - Phone:609-587-0400
Practice Address - Fax:609-587-4923
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPOD-11213E00000X
NJMD01901213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ581432Medicare ID - Type Unspecified