Healthcare Provider Details

I. General information

NPI: 1942512686
Provider Name (Legal Business Name): RICHARD ANTHONY CIULLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MOHAWK ST
COHOES NY
12047-2600
US

IV. Provider business mailing address

1I TREASURE LN
CLIFTON PARK NY
12065-4641
US

V. Phone/Fax

Practice location:
  • Phone: 518-233-3100
  • Fax: 518-233-3131
Mailing address:
  • Phone: 518-588-5870
  • Fax: 518-233-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number152720
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: