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General NPI Number Information
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NPI Number | 1265805725
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Entity Type | Individual
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Provider Name | CHANA KULEFSKY PAC
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Gender | Female
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 856 DEKALB AVE
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City | BROOKLYN
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State | NY
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Zip | 11221-1402
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Country | US
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Telephone | 516-365-6167
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Fax |
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Provider Business Mailing Address
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Address Line | 146 BEACH 9TH ST APT 5E
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-5622
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Country | US
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Telephone | 917-589-9003
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 018966
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License Number State | NY
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