Healthcare Provider Details

I. General information

NPI: 1285719583
Provider Name (Legal Business Name): ROY G KULICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATER PLACE 11TH FLOOR
BRONX NY
10461
US

IV. Provider business mailing address

875 5TH AVE APT. 3E
NEW YORK NY
10065-4952
US

V. Phone/Fax

Practice location:
  • Phone: 347-577-4434
  • Fax: 347-577-4419
Mailing address:
  • Phone: 347-577-4472
  • Fax: 347-577-4419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number123619
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number123619
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: