=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386691798
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN LECUYER N.P.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2006
-----------------------------------------------------
Last Update Date | 11/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 FEATHERS DR
-----------------------------------------------------
City | PLATTSBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12901-6461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-324-7246
-----------------------------------------------------
Fax | 518-324-3366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 VALLEY DR
-----------------------------------------------------
City | PLATTSBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12901-6371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-563-3765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | F334099-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------