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General NPI Number Information
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NPI Number | 1043374986
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Entity Type | Individual
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Provider Name | NICOLE KULISEK MD
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Gender | Female
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 500 ARCOLA RD
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-3982
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Country | US
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Telephone | 646-942-6148
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 VALLEY FORGE CIR APT 1543
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-1150
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Country | US
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Telephone | 617-251-4803
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 249629
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 248629
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License Number State | NY
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