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 1:17 W RED BANK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1630
Mailing Address - Country:US
Mailing Address - Phone:856-845-6807
Mailing Address - Fax:856-845-3760
Practice Address - Street 1:17 W RED BANK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-845-6807
Practice Address - Fax:856-845-3760
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA58255207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP405902OtherOXFORD
NJF04775OtherHEALTHNET
NJ222173875OtherBLUE SHIELD
NJ222173875OtherUNIFORMED FAMILY SERVICES
NJ769732OtherAMERIHEALTH ADMINISTRATOR
PA0713776000OtherPENNSYLVANIA BLUE SHIELD
NJ0713776000OtherKEYSTONE
NJ110099862OtherRAILROAD MEDICARE
NJ6164901Medicaid
NJ0713776000OtherAMERIHEALTH
NJ1046902OtherHORIZON MERCY
NJ465892OtherAETNA HMO
NJ222173875OtherBLUE SHIELD
NJ0713776000OtherAMERIHEALTH
NJF04775OtherHEALTHNET