Healthcare Provider Details

I. General information

NPI: 1689682627
Provider Name (Legal Business Name): RUBEN ITAMAR KUZNIECKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E 34TH ST
NEW YORK NY
10016-4852
US

IV. Provider business mailing address

223 E 34TH ST
NEW YORK NY
10016-4852
US

V. Phone/Fax

Practice location:
  • Phone: 646-558-0806
  • Fax:
Mailing address:
  • Phone: 646-558-0806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number230989
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: