Healthcare Provider Details

I. General information

NPI: 1154693794
Provider Name (Legal Business Name): LORIE KUVYKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2012
Last Update Date: 01/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 LINCOLN BLVD APT # F15
LONG BEACH NY
11561-4447
US

IV. Provider business mailing address

65 LINCOLN BLVD APT # F15
LONG BEACH NY
11561-4447
US

V. Phone/Fax

Practice location:
  • Phone: 191-766-9016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number537595111
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number537595111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: