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General NPI Number Information
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NPI Number | 1619900354
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Entity Type | Organization
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Legal Business Name | OKSA MEDICAL PC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 9749 63RD DR
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City | REGO PARK
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State | NY
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Zip | 11374-2229
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Country | US
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Telephone | 718-396-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 9749 63RD DR
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City | REGO PARK
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State | NY
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Zip | 11374-2229
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Country | US
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Telephone | 718-396-1000
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PAVEL KULIK
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Credential | M.D.
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Telephone | 718-396-1000
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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 | 228241
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 211012
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 236385
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | N006031
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 224945
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License Number State | NY
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