Healthcare Provider Details

I. General information

NPI: 1083768030
Provider Name (Legal Business Name): DINA KUTCHER RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TPKE NASSAU UNIVERSITY MEDICAL CENTER
EAST MEADOW NY
11554-1859
US

IV. Provider business mailing address

10 OAKLEY DR
HUNTINGTON STATION NY
11746-3116
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-5419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009142
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: