MEDICARE: THOMAS F. CULLINAN PSYCHOLOGIST PH.D. P.C.

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	103G00000X	Clinical Neuropsychologist	5577	NY

General Provider Information

NPI Number	:	1295249001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS F. CULLINAN PSYCHOLOGIST PH.D. P.C.

Provider Business Mailing Address
First Line	:	2190 BOSTON RD APT 1A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1209
Country	:	US
Telephone Number	:	718-863-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2190 BOSTON RD APT 1A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1209
Country	:	US
Telephone Number	:	718-863-5300
Fax Number	:

Authorized Official
Title or Position	:	BILLER
Name	:	KIMBERLY A WELCH
Credential	:
Telephone Number	:	718-863-5300

Provider Enumeration Date	:	12/01/2017
Last Update Date	:	12/01/2017

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