Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 230604 | NY |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A96019 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD20050074 | NM |
NPI | 1396739777 |
---|---|
Provider Name | Dr. Paul Jan Kubiak |
First Address | Hewlett, NY 11557-1429 |
Second Address | Hewlett, NY 11557-1429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 26/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I39069 | (02) |