Provider Demographics
NPI:1952342610
Name:PANEL KULIK PHYSICIAN PC
Entity Type:Organization
Organization Name:PANEL KULIK PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KULIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-336-1777
Mailing Address - Street 1:PO 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:718-336-1777
Mailing Address - Fax:718-375-2735
Practice Address - Street 1:2000 KINGS HWY
Practice Address - Street 2:#1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-336-1777
Practice Address - Fax:718-375-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H70996Medicare UPIN
NY73Z101Medicare ID - Type Unspecified