| Doctor Name: | EVETTE KUBICHKO |
| NPI Number: | 1023462041 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 260745 |
| Business Practice Address: | 67 W Taconic Rd Wappingers Falls, NY - 125906632 |
| Business Phone Number: | 8453806311 |
| Business Fax Number: | |
| Mailing Address: | 67 W Taconic Rd, WAPPINGERS FALLS |
| State: | NY |
| Postal Code: | 125906632 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/15/2016 |
| NPI Last Update Date: | 04/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | 260745 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |