Provider Demographics
NPI:1891885737
Name:KULICK, ALEXANDER N (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:N
Last Name:KULICK
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 1:22 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3048
Mailing Address - Country:US
Mailing Address - Phone:212-633-0388
Mailing Address - Fax:
Practice Address - Street 1:369 LEXINGTON AVE
Practice Address - Street 2:19TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6506
Practice Address - Country:US
Practice Address - Phone:212-779-2944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164144-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08F962Medicare ID - Type Unspecified
NYE38235Medicare UPIN