Healthcare Provider Details

I. General information

NPI: 1962048421
Provider Name (Legal Business Name): LINDA MARGARET KUIKEN HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 ROME TABERG RD
ROME NY
13440-1759
US

IV. Provider business mailing address

131 ENTERPRISE RD
JOHNSTOWN NY
12095-3326
US

V. Phone/Fax

Practice location:
  • Phone: 315-337-4532
  • Fax: 315-337-6956
Mailing address:
  • Phone: 518-736-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14000050543
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: