Provider Demographics
NPI:1518043165
Name:KULIK, ALFRED DEAN (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:DEAN
Last Name:KULIK
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRIDGE PLZ N STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7586
Mailing Address - Country:US
Mailing Address - Phone:201-224-2020
Mailing Address - Fax:917-591-5070
Practice Address - Street 1:1 BRIDGE PLZ N STE 2
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7586
Practice Address - Country:US
Practice Address - Phone:201-224-2020
Practice Address - Fax:917-591-5070
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05262000207W00000X
NY176355207W00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09016Medicare UPIN
C09016Medicare UPIN
NJKU724717Medicare ID - Type UnspecifiedMEDICARE NJ
NY35E112Medicare ID - Type UnspecifiedMEDICARE NY 2