Healthcare Provider Details

I. General information

NPI: 1124390166
Provider Name (Legal Business Name): MRS. NICOLE PAOLILLO KUCHMEISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date: 09/27/2013
Reactivation Date: 12/20/2016

III. Provider practice location address

17837 146TH TER
JAMAICA NY
11434
US

IV. Provider business mailing address

17837 146TH TER
JAMAICA NY
11434-5330
US

V. Phone/Fax

Practice location:
  • Phone: 718-528-2238
  • Fax:
Mailing address:
  • Phone: 718-528-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: