=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942512686
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD ANTHONY CIULLA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2010
-----------------------------------------------------
Last Update Date | 07/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 MOHAWK ST
-----------------------------------------------------
City | COHOES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12047-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-233-3100
-----------------------------------------------------
Fax | 518-233-3131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1I TREASURE LN
-----------------------------------------------------
City | CLIFTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12065-4641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-588-5870
-----------------------------------------------------
Fax | 518-233-3131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083X0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Physician
-----------------------------------------------------
License Number | 152720
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------