Healthcare Provider Details

I. General information

NPI: 1376696997
Provider Name (Legal Business Name): GEORGE KIHICZAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MILLBURN AVE SUITE 111
MILLBURN NJ
07041-1943
US

IV. Provider business mailing address

116 MILLBURN AVE SUITE 111
MILLBURN NJ
07041-1943
US

V. Phone/Fax

Practice location:
  • Phone: 973-467-5499
  • Fax:
Mailing address:
  • Phone: 973-467-5499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA02533700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number25MA02533700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: