Healthcare Provider Details

I. General information

NPI: 1407496094
Provider Name (Legal Business Name): MRS. LARISSA KUCHYNSKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. LARISSA KUCHYNSKA

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 KINGS HWY
BROOKLYN NY
11234-2625
US

IV. Provider business mailing address

1440 67TH ST APT 3B
BROOKLYN NY
11219-6286
US

V. Phone/Fax

Practice location:
  • Phone: 718-951-2702
  • Fax:
Mailing address:
  • Phone: 347-436-5919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number719591
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: