Healthcare Provider Details

I. General information

NPI: 1114737020
Provider Name (Legal Business Name): KEVIN KURIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 NORTHERN BLVD
MANHASSET NY
11030-3013
US

IV. Provider business mailing address

1350 NORTHERN BLVD
MANHASSET NY
11030-3013
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-5357
  • Fax: 516-365-9601
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF311407-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: