Provider Demographics
NPI:1689778854
Name:KUKLA, HELENA JASNA (MD)
Entity Type:Individual
Prefix:DR
First Name:HELENA
Middle Name:JASNA
Last Name:KUKLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HELENA
Other - Middle Name:
Other - Last Name:KUPKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 LONGBOW ROAD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901
Mailing Address - Country:US
Mailing Address - Phone:845-368-3699
Mailing Address - Fax:845-368-0396
Practice Address - Street 1:120 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-634-8283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13555912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0084244OtherGHI
NY169213POtherHIP
NY0084244OtherGHI
NY169213POtherHIP