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General NPI Number Information
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NPI Number | 1457154635
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Entity Type | Individual
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Provider Name | DANIELLE RULLO
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Gender | Female
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 299 HALLOCK AVE
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1217
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Country | US
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Telephone | 631-397-0797
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Fax |
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Provider Business Mailing Address
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Address Line | 337 E PINE ST
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City | LONG BEACH
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State | NY
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Zip | 11561-2334
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Country | US
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Telephone | 516-860-6591
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 1175438
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License Number State | NY
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