Healthcare Provider Details

I. General information

NPI: 1346519345
Provider Name (Legal Business Name): ARLENE MARY KUCHCICKI REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 I U WILLETS RD
ROSLYN HEIGHTS NY
11577-2823
US

IV. Provider business mailing address

469 WOODBRIDGE LN
JERICHO NY
11753-2630
US

V. Phone/Fax

Practice location:
  • Phone: 516-333-8797
  • Fax: 516-333-8915
Mailing address:
  • Phone: 516-433-2861
  • Fax: 516-333-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number491139-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: