Healthcare Provider Details

I. General information

NPI: 1831356187
Provider Name (Legal Business Name): MARIA A VULLO RDMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 27TH ST
LONG ISLAND CITY NY
11101-3825
US

IV. Provider business mailing address

332 BLEECKER ST SUITE E-33
NEW YORK NY
10014-2980
US

V. Phone/Fax

Practice location:
  • Phone: 917-519-3474
  • Fax:
Mailing address:
  • Phone: 917-519-3474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number119067
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: