Provider Demographics
NPI:1467412643
Name:KULAK, RICHARD P (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:KULAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5100 W TAFT RD
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-452-2828
Mailing Address - Fax:315-452-2870
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE G
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-452-2829
Practice Address - Fax:315-452-2870
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY210974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG84751Medicare UPIN
NYCC2357Medicare PIN