Healthcare Provider Details

I. General information

NPI: 1205008752
Provider Name (Legal Business Name): BONNIE RACHEL KUPCHIK M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 STEWART AVE
GARDEN CITY NY
11530-4893
US

IV. Provider business mailing address

433 WALTON ST
WEST HEMPSTEAD NY
11552-3052
US

V. Phone/Fax

Practice location:
  • Phone: 516-631-8899
  • Fax:
Mailing address:
  • Phone: 516-483-1079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001615-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: