Healthcare Provider Details

I. General information

NPI: 1164671236
Provider Name (Legal Business Name): GILBERT PULIDO D.MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 CLINTON AVENUE
WASHINGTON TOWNSHIP NJ
07676
US

IV. Provider business mailing address

649 CLINTON AVENUE.
WASHINGTON TOWNSHIP NJ
07676
US

V. Phone/Fax

Practice location:
  • Phone: 201-358-2719
  • Fax:
Mailing address:
  • Phone: 201-358-2719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22D101419300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: