Provider Demographics
NPI:1346360575
Name:KWASNIK, HERBERT ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:ROBERT
Last Name:KWASNIK
Suffix:
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 1:130 WEST 86TH ST
Mailing Address - Street 2:3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4066
Mailing Address - Country:US
Mailing Address - Phone:212-595-6207
Mailing Address - Fax:
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:DEPART OF REHABILITATION MEDICINE 2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5425
Practice Address - Country:US
Practice Address - Phone:718-250-8142
Practice Address - Fax:718-250-8257
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120851208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
68F951Medicare ID - Type Unspecified
E62562Medicare UPIN