Healthcare Provider Details

I. General information

NPI: 1043869449
Provider Name (Legal Business Name): LAUREN MARIE KUTKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GARDEN CITY PLZ
GARDEN CITY NY
11530-3302
US

IV. Provider business mailing address

9 CHASE LN
BETHPAGE NY
11714-5903
US

V. Phone/Fax

Practice location:
  • Phone: 516-747-9030
  • Fax:
Mailing address:
  • Phone: 516-728-4659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: