Healthcare Provider Details

I. General information

NPI: 1457085169
Provider Name (Legal Business Name): LIEZEL A KUCHINSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 GIBSON RD
GOSHEN NY
10924-6709
US

IV. Provider business mailing address

53 GIBSON RD
GOSHEN NY
10924-6709
US

V. Phone/Fax

Practice location:
  • Phone: 845-291-0200
  • Fax: 845-291-0279
Mailing address:
  • Phone: 845-291-0200
  • Fax: 845-291-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number834381-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: