Provider Demographics
NPI:1487092011
Name:KUKSIN, JULIA ZELDA (AUD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ZELDA
Last Name:KUKSIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2278 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5122
Mailing Address - Country:US
Mailing Address - Phone:347-524-8665
Mailing Address - Fax:
Practice Address - Street 1:31-19 NEWTOWN AVE
Practice Address - Street 2:#2011
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102
Practice Address - Country:US
Practice Address - Phone:718-971-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY002756231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator