Provider Demographics
NPI:1629738299
Name:CURALTA MEDICAL LLC
Entity Type:Organization
Organization Name:CURALTA MEDICAL LLC
Other - Org Name:BOLTROPE PODIATRY LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEWIRTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-391-1113
Mailing Address - Street 1:74 PASCACK RD STE 6
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1942
Mailing Address - Country:US
Mailing Address - Phone:201-571-0214
Mailing Address - Fax:
Practice Address - Street 1:400 ROUTE 17 SOURTH
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07045
Practice Address - Country:US
Practice Address - Phone:201-445-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0899976Medicaid