Provider Demographics
NPI:1700814431
Name:KULIK, PAVEL (MD)
Entity Type:Individual
Prefix:MR
First Name:PAVEL
Middle Name:
Last Name:KULIK
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:P.O. BOX 351145
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-704-9909
Mailing Address - Fax:347-702-5419
Practice Address - Street 1:3066 BRIGHTON 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6488
Practice Address - Country:US
Practice Address - Phone:718-704-9909
Practice Address - Fax:347-702-5419
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2249452084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY73Z101Medicare ID - Type Unspecified