Healthcare Provider Details

I. General information

NPI: 1669228425
Provider Name (Legal Business Name): JULIO EUGENIO KUZMA MS, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 NANTUCKET LN
DEER PARK NY
11729-1013
US

IV. Provider business mailing address

26 NANTUCKET LN
DEER PARK NY
11729-1013
US

V. Phone/Fax

Practice location:
  • Phone: 718-607-9104
  • Fax:
Mailing address:
  • Phone: 718-607-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF353719-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: