Provider Demographics
NPI:1194751891
Name:KUZMICK, PETER JOHN (DO)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOHN
Last Name:KUZMICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 RT 71
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-223-4300
Mailing Address - Fax:732-223-5273
Practice Address - Street 1:235 RT 71
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-223-4300
Practice Address - Fax:732-223-5273
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04006100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1250001Medicaid
NJ022081Medicare PIN
C78863Medicare UPIN