Provider Demographics
NPI:1417003898
Name:PAVEL KULIK PHYSICIAN P.C.
Entity Type:Organization
Organization Name:PAVEL KULIK PHYSICIAN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KULIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-704-9909
Mailing Address - Street 1:P.O. BOX 351145
Mailing Address - Street 2:P.O. BOX 351145
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1145
Mailing Address - Country:US
Mailing Address - Phone:718-704-9909
Mailing Address - Fax:347-702-5419
Practice Address - Street 1:3066 BRIGHTON 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6461
Practice Address - Country:US
Practice Address - Phone:718-704-9909
Practice Address - Fax:347-702-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2249452081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02279683Medicaid
NYWEW371Medicare ID - Type Unspecified