Healthcare Provider Details

I. General information

NPI: 1700524394
Provider Name (Legal Business Name): JULIANNA VULTAGGIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 MIDDLE COUNTRY RD
SELDEN NY
11784-2503
US

IV. Provider business mailing address

358 1ST AVE
MASSAPEQUA PARK NY
11762-1649
US

V. Phone/Fax

Practice location:
  • Phone: 631-760-7800
  • Fax:
Mailing address:
  • Phone: 516-587-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: