Provider Demographics
NPI:1619038221
Name:KURUCZ, STEFAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:P
Last Name:KURUCZ
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 1:300 NORTH MIDDLETOWN ROAD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965
Mailing Address - Country:US
Mailing Address - Phone:845-735-4114
Mailing Address - Fax:845-732-8425
Practice Address - Street 1:300 NORTH MIDDLETOWN ROAD
Practice Address - Street 2:SUITE 11
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965
Practice Address - Country:US
Practice Address - Phone:845-735-4114
Practice Address - Fax:845-732-8425
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00390143Medicaid
B12820Medicare UPIN
NYB12820Medicare ID - Type Unspecified