Healthcare Provider Details

I. General information

NPI: 1467137133
Provider Name (Legal Business Name): YANA KUCHYNSKA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 KINGSLAND RD STE 3
CLIFTON NJ
07014-1915
US

IV. Provider business mailing address

8320 SILVER FOX RD
LOUISVILLE KY
40291-2671
US

V. Phone/Fax

Practice location:
  • Phone: 973-405-2548
  • Fax: 973-777-2060
Mailing address:
  • Phone: 347-884-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00732800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2331DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: