Provider Demographics
NPI:1043890767
Name:KUCICH, ALISON P
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:P
Last Name:KUCICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WOODLAND DR S
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3642
Mailing Address - Country:US
Mailing Address - Phone:917-331-5665
Mailing Address - Fax:
Practice Address - Street 1:18 WOODLAND DR S
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3642
Practice Address - Country:US
Practice Address - Phone:917-331-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty