Provider Demographics
NPI:1801568605
Name:CURALTA MEDICAL LLC
Entity type:Organization
Organization Name:CURALTA MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ZANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-733-3879
Mailing Address - Street 1:201 STATE RT 17 STE 604
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2574
Mailing Address - Country:US
Mailing Address - Phone:201-571-0214
Mailing Address - Fax:
Practice Address - Street 1:74 PASCACK RD STE 6
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1942
Practice Address - Country:US
Practice Address - Phone:201-391-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0899976Medicaid