Healthcare Provider Details

I. General information

NPI: 1194949941
Provider Name (Legal Business Name): VENKAT R PULIJAAL PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE BELLEVUE HOSPITAL
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

462 1ST AVE BELLEVUE HOSPITAL
NEW YORK NY
10016-9196
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-6454
  • Fax: 212-263-7930
Mailing address:
  • Phone: 212-263-6454
  • Fax: 212-263-7930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberCOQ 31358
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: