Provider Demographics
NPI:1619158672
Name:KUTASH, IRWIN LAWRENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:LAWRENCE
Last Name:KUTASH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 EAST NORTHFIELD RD
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:201-738-4483
Mailing Address - Fax:
Practice Address - Street 1:340 EAST NORTHFIELD RD
Practice Address - Street 2:SUITE 1E
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:201-738-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ983103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJKU601406Medicare UPIN
NJKU601406Medicare PIN