Healthcare Provider Details

I. General information

NPI: 1417690231
Provider Name (Legal Business Name): BETTY KUI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 W ROUTE 59
NANUET NY
10954-2225
US

IV. Provider business mailing address

6313 83RD PL
MIDDLE VILLAGE NY
11379-1949
US

V. Phone/Fax

Practice location:
  • Phone: 845-510-2200
  • Fax: 845-215-5611
Mailing address:
  • Phone: 609-664-6634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number028536
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: