Provider Demographics
NPI:1487301164
Name:RICH, KEVIN (NP)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:RICH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4206
Mailing Address - Country:US
Mailing Address - Phone:631-478-9763
Mailing Address - Fax:631-980-3686
Practice Address - Street 1:150 MOTOR PKWY STE 401
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5108
Practice Address - Country:US
Practice Address - Phone:631-238-1509
Practice Address - Fax:631-980-3686
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY403050363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health