Provider Demographics
NPI:1477522712
Name:KUTNER, DONALD HAROLD (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:HAROLD
Last Name:KUTNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15-01 BROADWAY STE 34
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6006
Mailing Address - Country:US
Mailing Address - Phone:201-794-6808
Mailing Address - Fax:201-797-6238
Practice Address - Street 1:15-01 BROADWAY
Practice Address - Street 2:SUITE 34
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6003
Practice Address - Country:US
Practice Address - Phone:201-794-6808
Practice Address - Fax:201-797-6238
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB40513207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0714607Medicaid
NJKU75571Medicare ID - Type Unspecified
NJ071467Medicaid