1942418645 NPI number — MRS. CARLENE NOELLE KUCZMA MPT

Table of content: MRS. CARLENE NOELLE KUCZMA MPT (NPI 1942418645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942418645 NPI number — MRS. CARLENE NOELLE KUCZMA MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUCZMA
Provider First Name:
CARLENE
Provider Middle Name:
NOELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARENTS
Provider Other First Name:
CARLENE
Provider Other Middle Name:
NOELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942418645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
137 SHAGBARK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPEWELL JUNCTION
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12533-5281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-592-0739
Provider Business Mailing Address Fax Number:
845-592-0739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 BOCES DR
Provider Second Line Business Practice Location Address:
PINES BRIDGE SCHOOL
Provider Business Practice Location Address City Name:
YORKTOWN HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10598-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-248-2257
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  021717-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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