Healthcare Provider Details

I. General information

NPI: 1679729701
Provider Name (Legal Business Name): EUGENE F KUCHNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TALLMADGE GATE
SETAUKET NY
11733-1418
US

IV. Provider business mailing address

PO BOX 2801
SETAUKET NY
11733-0860
US

V. Phone/Fax

Practice location:
  • Phone: 631-689-8884
  • Fax: 631-689-0250
Mailing address:
  • Phone: 631-689-8884
  • Fax: 631-689-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number112597
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: