Healthcare Provider Details

I. General information

NPI: 1821194952
Provider Name (Legal Business Name): STEPHEN F KUCZYNSKI R.PH., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W KINGSBRIDGE RD
BRONX NY
10468-3904
US

IV. Provider business mailing address

18420 ABERDEEN RD
JAMAICA NY
11432-1516
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax: 718-741-4406
Mailing address:
  • Phone: 718-380-1747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number026486
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: