MEDICARE: RICHARD KUBIAK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	169449	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326014556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD KUBIAK MD

Provider Business Mailing Address
First Line	:	185 OLD COUNTRY RD
Second Line	:	SUITE 2
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2121
Country	:	US
Telephone Number	:	631-298-4479
Fax Number	:	631-591-3047

Provider Business Practice Location Address
First Line	:	54 WOODVILLE RD
Second Line	:
City	:	SHOREHAM
State	:	NY
Zip	:	11786-1331
Country	:	US
Telephone Number	:	631-929-1256
Fax Number	:	631-929-8313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	06/13/2016

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