Provider Demographics
NPI:1033527569
Name:KURUC, NICHOLAS (BS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:KURUC
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:160 MIDLAND RD
Practice Address - Street 2:PALADIN HOUSE
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3415
Practice Address - Country:US
Practice Address - Phone:203-597-1935
Practice Address - Fax:203-597-8811
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCERTOtherCOMMUNITY EMERGENCY RESPONSE TEAM