Individual
KONRAD KIECUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3705 80TH ST, JACKSON HEIGHTS, NY 11372-6870
(929) 229-9085
Mailing address
11506 ROCKAWAY BEACH BLVD, ROCKAWAY PARK, NY 11694-2346
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/27/2022
Last updated
04/27/2022
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