Healthcare Provider Details

I. General information

NPI: 1497196562
Provider Name (Legal Business Name): LEE ANNE ZINCK KUKS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 LONGWOOD RD
MIDDLE ISLAND NY
11953-2045
US

IV. Provider business mailing address

150 SWAN LN
LEVITTOWN NY
11756-4437
US

V. Phone/Fax

Practice location:
  • Phone: 631-924-0008
  • Fax: 631-924-4602
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number738043
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: