Healthcare Provider Details

I. General information

NPI: 1013594100
Provider Name (Legal Business Name): TINA LULLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 WESTCHESTER AVE STE A
BRONX NY
10461-3585
US

IV. Provider business mailing address

2510 WESTCHESTER AVE STE A
BRONX NY
10461-3585
US

V. Phone/Fax

Practice location:
  • Phone: 718-517-3030
  • Fax: 718-517-3031
Mailing address:
  • Phone: 718-517-3030
  • Fax: 718-517-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number341341
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: