Healthcare Provider Details

I. General information

NPI: 1720314743
Provider Name (Legal Business Name): GERALD ALLEN PULIS JR. LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 HIGH ST
NAPANOCH NY
12458-2810
US

IV. Provider business mailing address

29 HIGH ST
NAPANOCH NY
12458-2810
US

V. Phone/Fax

Practice location:
  • Phone: 845-741-5339
  • Fax: 718-322-6836
Mailing address:
  • Phone: 845-741-5339
  • Fax: 718-322-6836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number019472
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: