Healthcare Provider Details

I. General information

NPI: 1538497292
Provider Name (Legal Business Name): MARINA KUCHER R.P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

280 MADISON AVE RM 905
NEW YORK NY
10016-0823
US

V. Phone/Fax

Practice location:
  • Phone: 917-816-0688
  • Fax:
Mailing address:
  • Phone: 212-696-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013736
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: