Provider Demographics
NPI:1902852957
Name:KAULBACK, KURT W (MD)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:W
Last Name:KAULBACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:732-790-0107
Practice Address - Street 1:698 MULLICA HILL RD STE 330
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-4453
Practice Address - Country:US
Practice Address - Phone:856-845-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05825500207RC0000X
NJMA58255207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0713776000OtherAMERIHEALTH
NJ222173875OtherUNIFORMED FAMILY SERVICES
NJ6164901Medicaid
PA0713776000OtherPENNSYLVANIA BLUE SHIELD
NJ110099862OtherRAILROAD MEDICARE
NJF04775OtherHEALTHNET
NJ0713776000OtherKEYSTONE
NJ1046902OtherHORIZON MERCY
NJ222173875OtherBLUE SHIELD
NJP405902OtherOXFORD
NJ465892OtherAETNA HMO
NJ769732OtherAMERIHEALTH ADMINISTRATOR
NJ222173875OtherBLUE SHIELD
NJ0713776000OtherAMERIHEALTH
NJF04775OtherHEALTHNET