Provider Demographics
NPI:1194738369
Name:KURIAKOSE, MARYKUTTY (MD)
Entity type:Individual
Prefix:DR
First Name:MARYKUTTY
Middle Name:
Last Name:KURIAKOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1611
Mailing Address - Country:US
Mailing Address - Phone:732-354-0159
Mailing Address - Fax:732-354-0147
Practice Address - Street 1:1174 EASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1611
Practice Address - Country:US
Practice Address - Phone:732-354-0159
Practice Address - Fax:732-354-0147
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39482207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1625306Medicaid
NJ1625306Medicaid
NJC60085Medicare UPIN