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General NPI Number Information
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NPI Number | 1386963254
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Entity Type | Organization
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Legal Business Name | MCCULLOCH ORTHOPAEDIC SURGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 12510 QUEENS BLVD STE 9
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City | KEW GARDENS
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State | NY
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Zip | 11415
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Country | US
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Telephone | 212-588-1919
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Fax | 877-992-0798
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Provider Business Mailing Address
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Address Line | 520 FRANKLIN AVE STE 212
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City | GARDEN CITY
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State | NY
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Zip | 11530-5815
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Country | US
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Telephone | 212-588-1919
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Fax | 212-588-1896
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Authorized Official
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Title or Position | CFO/COO
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Name | MR. ANDREW MCCULLOCH
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Credential |
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Telephone | 718-275-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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