Provider Demographics
NPI:1023729829
Name:KACZMAR, KURT (PA-C)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:
Last Name:KACZMAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS ROAD - ENTA
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-2770
Mailing Address - Country:US
Mailing Address - Phone:914-984-2552
Mailing Address - Fax:
Practice Address - Street 1:261 5TH AVE RM 901
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7601
Practice Address - Country:US
Practice Address - Phone:212-679-3499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2024-09-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant