Healthcare Provider Details

I. General information

NPI: 1841476405
Provider Name (Legal Business Name): PHILLIP C CULLITON DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SHERIDAN DR
TONAWANDA NY
14150-9462
US

IV. Provider business mailing address

2700 SHERIDAN DR
TONAWANDA NY
14150-9462
US

V. Phone/Fax

Practice location:
  • Phone: 716-835-2617
  • Fax:
Mailing address:
  • Phone: 716-835-2617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003003-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberN003003
License Number StateNY

VIII. Authorized Official

Name: PHILLIP C CULLITON
Title or Position: DPM
Credential:
Phone: 716-835-2617