Provider Demographics
NPI:1801019476
Name:KULICK, AARON R (MD)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:R
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 1:1100 PARK AVE
Mailing Address - Street 2:S 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1202
Mailing Address - Country:US
Mailing Address - Phone:212-410-0878
Mailing Address - Fax:212-410-0957
Practice Address - Street 1:1100 PARK AVE
Practice Address - Street 2:S 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1202
Practice Address - Country:US
Practice Address - Phone:212-410-0878
Practice Address - Fax:212-410-0957
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2000792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY09M701Medicare PIN
A58333Medicare UPIN