Healthcare Provider Details

I. General information

NPI: 1639522055
Provider Name (Legal Business Name): MULLEN P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PARK AVE SUITE 1700
NEW YORK NY
10166-0005
US

IV. Provider business mailing address

200 PARK AVE SUITE 1700
NEW YORK NY
10166-0005
US

V. Phone/Fax

Practice location:
  • Phone: 646-632-3718
  • Fax:
Mailing address:
  • Phone: 646-632-3718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. WESLEY M. MULLEN
Title or Position: ATTORNEY
Credential: JD
Phone: 646-632-3718