MEDICARE: JOHN C CUELLAR MD

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	207X00000X	Orthopaedic Surgery Physician	57538	MN
2	207XX0801X	Orthopaedic Trauma Physician	278797	NY

General Provider Information

NPI Number	:	1346547288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN C CUELLAR MD

Provider Business Mailing Address
First Line	:	661 DEER PARK AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-1300
Country	:	US
Telephone Number	:	631-376-0043
Fax Number	:

Provider Business Practice Location Address
First Line	:	661 DEER PARK AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-1300
Country	:	US
Telephone Number	:	631-376-0043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	09/28/2015

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Directions to “ JOHN C CUELLAR MD” Practice Location

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