Individual
BRIAN LUCAS KACZMAREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
380 GENESEE AVE, STATEN ISLAND, NY 10312-3296
(718) 984-3800
Mailing address
135 CORSON AVE, STATEN ISLAND, NY 10301-2933
(917) 719-1885
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
705571
NY
Other
Enumeration date
10/06/2020
Last updated
01/04/2024
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