Provider Demographics
NPI:1376696997
Name:KIHICZAK, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:KIHICZAK
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 1:116 MILLBURN AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1943
Mailing Address - Country:US
Mailing Address - Phone:973-467-5499
Mailing Address - Fax:
Practice Address - Street 1:116 MILLBURN AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1943
Practice Address - Country:US
Practice Address - Phone:973-467-5499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02533700207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1554701Medicaid
NJ1554701Medicaid
NJC55349Medicare UPIN