Organization Name: | KUBICKI PODIATRY PC |
NPI Number: | 1063442853 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JODY KUBICKI (DOCTOR) |
Mailing Address: | 130 W 2nd St Berwick |
State: | PA US |
Postal Code: | 186034749 |
Phone Number: | 5705795011 |
Fax Number: | 5705795040 |
NPI Enumeration Date: | 07/04/2006 |
NPI Last Update Date: | 08/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0131X |
License Number: | SC004606L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot Surgery |
Taxonomy Definition: |