Healthcare Provider Details

I. General information

NPI: 1487620407
Provider Name (Legal Business Name): EUGENE A. CULLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 ROUTE 94
COLUMBIA NJ
07832-2764
US

IV. Provider business mailing address

404 LIPPINCOTT DR
MARLTON NJ
08053-4112
US

V. Phone/Fax

Practice location:
  • Phone: 908-362-9285
  • Fax: 908-362-7756
Mailing address:
  • Phone: 856-782-3300
  • Fax: 565-048-0298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA67218
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: