Provider Demographics
NPI:1538134697
Name:KUCK, DAVID (PT DPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:KUCK
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MAIN RD
Mailing Address - Street 2:STE 4
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-1953
Mailing Address - Country:US
Mailing Address - Phone:631-208-2900
Mailing Address - Fax:631-208-2929
Practice Address - Street 1:31 MAIN RD
Practice Address - Street 2:STE 4
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-1953
Practice Address - Country:US
Practice Address - Phone:631-208-2900
Practice Address - Fax:631-208-2929
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025601 0225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3943267OtherAETNA HMO
NY7109712OtherAETNA PPO
NYQ11A8QD611Medicare PIN