Doctor Name: | JODY JONES KUBICKI |
NPI Number: | 1447227905 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | SC004606L |
Business Practice Address: | 130 W 2nd St Berwick, PA - 186034749 |
Business Phone Number: | 5707528426 |
Business Fax Number: | 5707595040 |
Mailing Address: | 130 W 2nd St, BERWICK |
State: | PA |
Postal Code: | 186034749 |
Phone Number: | 5707528426 |
Fax Number: | 5707595040 |
NPI Enumeration Date: | 03/03/2006 |
NPI Last Update Date: | 03/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | SC004606L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |