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General NPI Number Information
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NPI Number | 1063442853
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Entity Type | Organization
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Legal Business Name | KUBICKI PODIATRY PC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 130 W 2ND ST
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City | BERWICK
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State | PA
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Zip | 18603-4749
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Country | US
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Telephone | 570-579-5011
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Fax | 570-579-5040
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Provider Business Mailing Address
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Address Line | 130 W 2ND ST
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City | BERWICK
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State | PA
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Zip | 18603-4749
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Country | US
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Telephone | 570-579-5011
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Fax | 570-579-5040
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Authorized Official
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Title or Position | DOCTOR
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Name | JODY KUBICKI
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Credential | DPM
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Telephone | 570-759-5011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | SC004606L
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License Number State | PA
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