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NPI Code Detail

MEDICARE: LAITH F. GULLI M.D.,M.SC.,MSA,M.SC.

MEDICARE:   LAITH F. GULLI  M.D.,M.SC.,MSA,M.SC.
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
1103TC0700XClinical Psychologist6301011936MI
2106H00000XMarriage & Family Therapist06000343NY

General Provider Information

NPI Number : 1295792257
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAITH F. GULLI M.D.,M.SC.,MSA,M.SC.
Provider Business Mailing Address
First Line : 36 BRITISH AMERICAN BLVD STE 102
Second Line :
City : LATHAM
State : NY
Zip : 12110-1410
Country : US
Telephone Number : 518-389-6606
Fax Number :
Provider Business Practice Location Address
First Line : 350 ELK ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-7351
Country : US
Telephone Number : 605-343-7262
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 02/26/2019

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Directions to “ LAITH F. GULLI M.D.,M.SC.,MSA,M.SC.” Practice Location

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