Provider Demographics
NPI:1114912367
Name:KALMUK, EUGENE JAMES JR (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:JAMES
Last Name:KALMUK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 HARLEM RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4031
Mailing Address - Country:US
Mailing Address - Phone:716-893-4797
Mailing Address - Fax:716-893-1697
Practice Address - Street 1:2625 HARLEM RD
Practice Address - Street 2:SUITE 180
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4031
Practice Address - Country:US
Practice Address - Phone:716-893-4797
Practice Address - Fax:716-893-1697
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1613451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00891832Medicaid
NY000510526007OtherBCBS
NYJ400056489Medicare PIN
NY00891832Medicaid