MEDICARE: DR. MICHAEL KUNCEWITCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician	276574	NY

General Provider Information

NPI Number	:	1245468321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL KUNCEWITCH M.D.

Provider Business Mailing Address
First Line	:	3040 SHORE DR
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-5228
Country	:	US
Telephone Number	:	516-306-0048
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 WOODCHUCK HOLLOW RD
Second Line	:
City	:	COLD SPRING HARBOR
State	:	NY
Zip	:	11724-2436
Country	:	US
Telephone Number	:	516-306-0048
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2009
Last Update Date	:	03/07/2019

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