Provider Demographics
NPI:1417690231
Name:KUI, BETTY (PA-C)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:KUI
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6313 83RD PL
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1949
Mailing Address - Country:US
Mailing Address - Phone:609-664-6634
Mailing Address - Fax:
Practice Address - Street 1:233 W ROUTE 59
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2225
Practice Address - Country:US
Practice Address - Phone:845-510-2200
Practice Address - Fax:845-215-5611
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028536363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty