Healthcare Provider Details

I. General information

NPI: 1114988656
Provider Name (Legal Business Name): STEVEN G KUCHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 W JERICHO TPKE
SMITHTOWN NY
11787-3203
US

IV. Provider business mailing address

987 W JERICHO TPKE
SMITHTOWN NY
11787-3203
US

V. Phone/Fax

Practice location:
  • Phone: 631-864-9100
  • Fax: 631-864-2143
Mailing address:
  • Phone: 631-864-9100
  • Fax: 631-864-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number135412-2
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number135412-2
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number135412-2
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number135412-2
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: