Healthcare Provider Details

I. General information

NPI: 1467548867
Provider Name (Legal Business Name): JOSEPH A KUZEMCHAK CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HORIZON DRIVE
HUNTINGTON NY
11743
US

IV. Provider business mailing address

26 WEST COURT DRIVE
CENTEREACH NY
11720
US

V. Phone/Fax

Practice location:
  • Phone: 631-920-8072
  • Fax:
Mailing address:
  • Phone: 631-588-0511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: