Healthcare Provider Details

I. General information

NPI: 1417003898
Provider Name (Legal Business Name): PAVEL KULIK PHYSICIAN P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 BRIGHTON 6TH ST
BROOKLYN NY
11235-6461
US

IV. Provider business mailing address

P.O. BOX 351145 P.O. BOX 351145
BROOKLYN NY
11235-1145
US

V. Phone/Fax

Practice location:
  • Phone: 718-704-9909
  • Fax: 347-702-5419
Mailing address:
  • Phone: 718-704-9909
  • Fax: 347-702-5419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number224945
License Number StateNY

VIII. Authorized Official

Name: DR. PAVEL KULIK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-704-9909