Provider Demographics
NPI:1437112042
Name:KUTZLEB, JUDITH (NP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:KUTZLEB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT AVE
Mailing Address - Street 2:HACKENSACK UNIVERSITY MEDICAL CENTER
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1914
Mailing Address - Country:US
Mailing Address - Phone:201-996-2609
Mailing Address - Fax:201-487-3499
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:HACKENSACK UNIVERSITY MEDICAL CENTER
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1914
Practice Address - Country:US
Practice Address - Phone:201-996-2609
Practice Address - Fax:201-487-3499
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00074100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0093343Medicaid
B29263Medicare UPIN
NJ085645Medicare ID - Type Unspecified