MEDICARE: MADELYN D. PULLMAN, MD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	122312	NY

General Provider Information

NPI Number	:	1164513206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADELYN D. PULLMAN, MD, LLC

Provider Business Mailing Address
First Line	:	1551 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2313
Country	:	US
Telephone Number	:	718-987-5330
Fax Number	:	718-984-8812

Provider Business Practice Location Address
First Line	:	1551 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2313
Country	:	US
Telephone Number	:	718-987-5330
Fax Number	:	718-984-8812

Authorized Official
Title or Position	:	OWNER
Name	:	MADELYN D PULLMAN
Credential	:	M.D.
Telephone Number	:	718-987-5330

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	04/23/2008

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