Provider Demographics
NPI:1366556433
Name:KUBIS, JURAJ (MD)
Entity type:Individual
Prefix:DR
First Name:JURAJ
Middle Name:
Last Name:KUBIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 JEFFERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2428
Mailing Address - Country:US
Mailing Address - Phone:516-248-2299
Mailing Address - Fax:516-248-2316
Practice Address - Street 1:153 JEFFERSON AVENUE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2428
Practice Address - Country:US
Practice Address - Phone:516-248-2299
Practice Address - Fax:516-248-2316
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117593207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B12577Medicare UPIN
NY301601Medicare ID - Type Unspecified