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General NPI Number Information
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NPI Number | 1689778854
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Entity Type | Individual
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Provider Name | HELENA JASNA KUKLA MD
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Gender | Female
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 120 NORTH MAIN STREET
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City | NEW CITY
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State | NY
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Zip | 10956
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Country | US
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Telephone | 845-634-8283
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Fax |
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Provider Business Mailing Address
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Address Line | 4 LONGBOW ROAD
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City | SUFFERN
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State | NY
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Zip | 10901
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Country | US
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Telephone | 845-368-3699
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Fax | 845-368-0396
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 1355591
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License Number State | NY
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