Healthcare Provider Details

I. General information

NPI: 1427497924
Provider Name (Legal Business Name): ANNA M CIURLEO-WALZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARIA CIURLEO MSED

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7530 61ST ST
GLENDALE NY
11385-6124
US

IV. Provider business mailing address

75-30 61ST STREET
GLENDALE NY
11385
US

V. Phone/Fax

Practice location:
  • Phone: 917-951-5562
  • Fax:
Mailing address:
  • Phone: 917-951-5562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: