Provider Demographics
NPI:1952730350
Name:FUKSMAN, KRISTOPHER MICHAL
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:MICHAL
Last Name:FUKSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W 82ND ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5608
Mailing Address - Country:US
Mailing Address - Phone:646-285-6344
Mailing Address - Fax:
Practice Address - Street 1:35 W 82ND ST APT 6A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5608
Practice Address - Country:US
Practice Address - Phone:646-285-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY719460131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY719460131OtherSPECIAL EDUCATION