Healthcare Provider Details

I. General information

NPI: 1689463531
Provider Name (Legal Business Name): KURT MACDONALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

105 E 19TH ST APT 2A
NEW YORK NY
10003-2139
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-6911
  • Fax:
Mailing address:
  • Phone: 908-770-9598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383815
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: