Provider Demographics
NPI:1659699015
Name:KUKLOV, ALEKSEY (MD)
Entity Type:Individual
Prefix:
First Name:ALEKSEY
Middle Name:
Last Name:KUKLOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 DURHAM DR
Mailing Address - Street 2:APT D
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2448
Mailing Address - Country:US
Mailing Address - Phone:716-579-0191
Mailing Address - Fax:
Practice Address - Street 1:70 HATFIELD LN
Practice Address - Street 2:SUITE 201
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6734
Practice Address - Country:US
Practice Address - Phone:845-294-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257015207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology