Healthcare Provider Details

I. General information

NPI: 1053648154
Provider Name (Legal Business Name): SOFYA KUCHUK ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST RM 802
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

3711 94TH ST # 2
JACKSON HEIGHTS NY
11372-7933
US

V. Phone/Fax

Practice location:
  • Phone: 646-714-6514
  • Fax:
Mailing address:
  • Phone: 646-541-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number430490
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: