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General NPI Number Information
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NPI Number | 1497425904
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Entity Type | Individual
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Provider Name | MICAELA GRACE KUBE PA
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Gender | Female
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 65 BROADWAY STE 1800
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City | NEW YORK
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State | NY
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Zip | 10006-2549
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Country | US
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Telephone | 646-665-3634
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 QUEENS PLZ N
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-4020
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Country | US
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Telephone | 122-283-3000
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Fax | 646-665-3604
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1185508
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00629400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 027198
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License Number State | NY
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