MEDICARE: MR. PAVEL KULIK M.D.

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	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	224945	NY

General Provider Information

NPI Number	:	1700814431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAVEL KULIK M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 351145
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	718-704-9909
Fax Number	:	347-702-5419

Provider Business Practice Location Address
First Line	:	3066 BRIGHTON 6TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6488
Country	:	US
Telephone Number	:	718-704-9909
Fax Number	:	347-702-5419

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	10/08/2014

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