Healthcare Provider Details

I. General information

NPI: 1053762351
Provider Name (Legal Business Name): ELEONORA Z. KUZMA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 PARK AVE SUITE 140
HUNTINGTON NY
11743-3975
US

IV. Provider business mailing address

755 PARK AVE SUITE 140
HUNTINGTON NY
11743-3975
US

V. Phone/Fax

Practice location:
  • Phone: 631-405-9334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number021660
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: