Healthcare Provider Details

I. General information

NPI: 1417632084
Provider Name (Legal Business Name): EMMA CULLETON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE # EL3
NEWARK NJ
07112-2027
US

IV. Provider business mailing address

201 LYONS AVE STE EL3
NEWARK NJ
07112-2027
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-6671
  • Fax: 973-282-0562
Mailing address:
  • Phone: 973-926-6671
  • Fax: 973-282-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA13158300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: