Healthcare Provider Details

I. General information

NPI: 1790304756
Provider Name (Legal Business Name): MEHMET UTKU KUCUKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK AVE FL 7
NEW YORK NY
10016-5818
US

IV. Provider business mailing address

33 HUDSON ST APT 2504E
JERSEY CITY NJ
07302-6591
US

V. Phone/Fax

Practice location:
  • Phone: 507-271-6822
  • Fax:
Mailing address:
  • Phone: 507-271-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number324810
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: