Provider Demographics
NPI:1386600914
Name:KAFKA, NICOLE J (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:KAFKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W 96TH ST STE 1F
Mailing Address - Street 2:KAFKACARE MEDICAL, PLLC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6403
Mailing Address - Country:US
Mailing Address - Phone:212-688-2100
Mailing Address - Fax:
Practice Address - Street 1:145 W 96TH ST STE 1F
Practice Address - Street 2:KAFKACARE MEDICAL, PLLC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6403
Practice Address - Country:US
Practice Address - Phone:212-688-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181153208C00000X, 208600000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G65228Medicare UPIN
NY000281Medicare ID - Type Unspecified