Healthcare Provider Details

I. General information

NPI: 1184948861
Provider Name (Legal Business Name): ANASTASIA KUNAC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST UNIVERSITY HOSPITAL DIVISION OF TRAUMA
NEWARK NJ
07103-2496
US

IV. Provider business mailing address

150 BERGEN ST MEZZANINE M-229
NEWARK NJ
07103-2496
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-4900
  • Fax:
Mailing address:
  • Phone: 973-972-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number25MA08787500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number049990
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: