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General NPI Number Information
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NPI Number | 1245611854
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Entity Type | Individual
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Provider Name | SABRINA EMERALD KUNCIW M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2015
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 11050 MT BELVEDERE BLVD
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City | FORT DRUM
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State | NY
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Zip | 13602-2603
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Country | US
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Telephone | 315-772-2964
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Fax |
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Provider Business Mailing Address
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Address Line | 528 CONSTITUTION DR
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City | EPHRATA
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State | PA
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Zip | 17522-9177
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101261371
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License Number State | VA
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