Healthcare Provider Details

I. General information

NPI: 1508687674
Provider Name (Legal Business Name): ALBINA KUKIC PA-C, M.SC., B.SC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1000
  • Fax:
Mailing address:
  • Phone: 718-270-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number033027
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: