Healthcare Provider Details

I. General information

NPI: 1902874167
Provider Name (Legal Business Name): MARIOLA B KUBICKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MERIDIAN CENTRE STE 300
ROCHESTER NY
14618-3984
US

IV. Provider business mailing address

300 MERIDIAN CENTRE STE 300
ROCHESTER NY
14618-3984
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-0150
  • Fax: 585-271-8704
Mailing address:
  • Phone: 585-442-0150
  • Fax: 585-271-8704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number164775
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: