Healthcare Provider Details

I. General information

NPI: 1902977051
Provider Name (Legal Business Name): GEORGE E KUZMA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 SUSQUEHANNA BLVD
W HAZLETON PA
18202-1118
US

IV. Provider business mailing address

170 SUSQUEHANNA BLVD
W HAZLETON PA
18202-1118
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-2000
  • Fax: 570-459-2002
Mailing address:
  • Phone: 570-459-2000
  • Fax: 570-459-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC002868L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: