Provider Demographics
NPI:1285910737
Name:KUTOVY, VICTOR (MA, ATC)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:KUTOVY
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1502
Mailing Address - Country:US
Mailing Address - Phone:973-543-2501
Mailing Address - Fax:973-543-6150
Practice Address - Street 1:65 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-1502
Practice Address - Country:US
Practice Address - Phone:973-543-2501
Practice Address - Fax:973-543-6150
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000978002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer