Healthcare Provider Details

I. General information

NPI: 1205831716
Provider Name (Legal Business Name): SANUL CORRIELUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 OLD YORK RD STE 309
JENKINTOWN PA
19046-3709
US

IV. Provider business mailing address

628 MANOR RD
PENN VALLEY PA
19072-1617
US

V. Phone/Fax

Practice location:
  • Phone: 215-383-5900
  • Fax: 215-842-5950
Mailing address:
  • Phone: 215-383-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD073627L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.151360
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: