Provider Demographics
NPI:1508931742
Name:KUCZABSKI, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:KUCZABSKI
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:PO BOX 140399
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-0399
Mailing Address - Country:US
Mailing Address - Phone:718-720-9040
Mailing Address - Fax:718-720-9041
Practice Address - Street 1:2131 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2574
Practice Address - Country:US
Practice Address - Phone:718-720-9040
Practice Address - Fax:718-720-9041
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212569208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01978303Medicaid
NY82L822Medicare PIN