Provider Demographics
NPI:1922328236
Name:PACHUCKI, KEVIN CHRISTOPHER (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:CHRISTOPHER
Last Name:PACHUCKI
Suffix:
Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:1240 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9222
Practice Address - Country:US
Practice Address - Phone:518-439-2460
Practice Address - Fax:518-439-3025
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2018-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY014000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03250180Medicaid
NY100826000018OtherFIDELIS
NY03250180Medicaid