Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 25MA07615000 | NJ |
NPI | 1083619860 |
---|---|
Provider Name | Dr. Anthony Cultrara |
First Address | Philadelphia, PA 19195-5585 |
Second Address | Cherry Hill, NJ 08034-1906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 28/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0072857000 | AMERIHEALTH (01) | NJ |
134233377 | HORIZON (01) | NJ |
2682508 | (05) | NJ |
3321541 | AETNA (01) | NJ |
H99774 | (02) | NJ |