Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | S5000 | TX |
N | 2080P0204X | Pediatric Emergency Doctor | 213458 | NY |
N | 2080P0204X | Pediatric Emergency Doctor | S5000 | TX |
NPI | 1447332689 |
---|---|
Provider Name | Sergey Kunkov |
First Address | Stony Brook, NY 11790-0989 |
Second Address | Stony Brook, NY 11794-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 03/12/2021 |