Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 155618 | NY |
N | 207RC0000X | Internist - Cardiovascular Disease | 155168 | NY |
NPI | 1609869551 |
---|---|
Provider Name | Dr. Marrick L Kukin |
First Address | New York, NY 10075-1851 |
Second Address | New York, NY 10028-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 19/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01105820 | (05) | NY |
A60978 | (02) | NY |