Healthcare Provider Details

I. General information

NPI: 1902181597
Provider Name (Legal Business Name): ANDREW KUIKEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2011
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E RIDGEWOOD AVE SUITE 200
RIDGEWOOD NJ
07450-3957
US

IV. Provider business mailing address

1200 E RIDGEWOOD AVE SUITE 200
RIDGEWOOD NJ
07450-3957
US

V. Phone/Fax

Practice location:
  • Phone: 201-327-8600
  • Fax:
Mailing address:
  • Phone: 201-327-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number016359-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112825
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00271400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: