Healthcare Provider Details

I. General information

NPI: 1568645422
Provider Name (Legal Business Name): JOSEPH JAMES GULOTTA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 MAIN ST
LAKE COMO NJ
07719-3096
US

IV. Provider business mailing address

10 OCEAN BLVD APT 3B
ATLANTIC HIGHLANDS NJ
07716-1252
US

V. Phone/Fax

Practice location:
  • Phone: 732-681-2200
  • Fax:
Mailing address:
  • Phone: 610-209-2078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00617800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: