Provider Demographics
NPI:1942381371
Name:KALNICKI, SHALOM (MD)
Entity Type:Individual
Prefix:
First Name:SHALOM
Middle Name:
Last Name:KALNICKI
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 1:3636 WALDO AVE
Mailing Address - Street 2:APT 3H & J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2247
Mailing Address - Country:US
Mailing Address - Phone:718-405-8550
Mailing Address - Fax:718-405-8551
Practice Address - Street 1:CENTER FOR RADIATION THERAPY
Practice Address - Street 2:1625 POPLAR STREET, 1ST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-405-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1374122085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology