Provider Demographics
NPI:1063442853
Name:KUBICKI PODIATRY PC
Entity Type:Organization
Organization Name:KUBICKI PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBICKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-759-5011
Mailing Address - Street 1:130 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-4749
Mailing Address - Country:US
Mailing Address - Phone:570-579-5011
Mailing Address - Fax:570-579-5040
Practice Address - Street 1:130 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4749
Practice Address - Country:US
Practice Address - Phone:570-579-5011
Practice Address - Fax:570-579-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004606L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC004606LOtherLICENSE #
PASC004606LOtherLICENSE #