Provider Demographics
NPI:1467539189
Name:KUKOR, JOHN J (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:KUKOR
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2102
Mailing Address - Country:US
Mailing Address - Phone:516-354-3121
Mailing Address - Fax:
Practice Address - Street 1:26 ABERDEEN RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2102
Practice Address - Country:US
Practice Address - Phone:516-354-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health