Doctor Name: | SOPHIA KICIUK |
NPI Number: | 1114170701 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | F330452-1 |
Business Practice Address: | 592 Route 22 Ste 1b Pawling, NY - 125641219 |
Business Phone Number: | 8454930274 |
Business Fax Number: | 8454930279 |
Mailing Address: | 592 Route 22 Ste 1b, PAWLING |
State: | NY |
Postal Code: | 125641219 |
Phone Number: | 8454930274 |
Fax Number: | 8454930279 |
NPI Enumeration Date: | 10/28/2008 |
NPI Last Update Date: | 06/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | F330452-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |