Healthcare Provider Details

I. General information

NPI: 1265914824
Provider Name (Legal Business Name): LINDA NOREEN CULLOTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MOTT LN
BROOKHAVEN NY
11719-9620
US

IV. Provider business mailing address

998 CROOKED HILL RD
WEST BRENTWOOD NY
11717-1019
US

V. Phone/Fax

Practice location:
  • Phone: 631-538-9507
  • Fax:
Mailing address:
  • Phone: 631-761-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number746911
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: