Healthcare Provider Details

I. General information

NPI: 1508931742
Provider Name (Legal Business Name): GEORGE KUCZABSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 RICHMOND RD
STATEN ISLAND NY
10306-2574
US

IV. Provider business mailing address

PO BOX 140399
STATEN ISLAND NY
10314-0399
US

V. Phone/Fax

Practice location:
  • Phone: 718-720-9040
  • Fax: 718-720-9041
Mailing address:
  • Phone: 718-720-9040
  • Fax: 718-720-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number212569
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: