Healthcare Provider Details

I. General information

NPI: 1356618342
Provider Name (Legal Business Name): JEAN KUROSKI R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MILL RD
REMSENBURG NY
11960-0900
US

IV. Provider business mailing address

P.O BOX 673
EAST QUOGUE NY
11942
US

V. Phone/Fax

Practice location:
  • Phone: 631-325-0203
  • Fax:
Mailing address:
  • Phone: 631-325-0203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number354793-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: