Provider Demographics
NPI:1518348937
Name:KULYNYCH, LORI
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:KULYNYCH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:CAGGIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:4 40TH ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-1106
Mailing Address - Country:US
Mailing Address - Phone:631-277-2165
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3415
Practice Address - Country:US
Practice Address - Phone:631-943-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0167881225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist