Provider Demographics
NPI:1528069416
Name:KUCUK, ERHAN (MD)
Entity type:Individual
Prefix:DR
First Name:ERHAN
Middle Name:
Last Name:KUCUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 HAMBURG TPKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8482
Mailing Address - Country:US
Mailing Address - Phone:973-595-0096
Mailing Address - Fax:973-595-6414
Practice Address - Street 1:508 HAMBURG TPKE
Practice Address - Street 2:SUITE 102
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8482
Practice Address - Country:US
Practice Address - Phone:973-595-0096
Practice Address - Fax:973-595-6414
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05418800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5051908Medicaid
NJ654082NEMMedicare PIN
NJE59529Medicare UPIN