MEDICARE: DR. DENISE MARIE CERULLO D.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	111N00000X	Chiropractor	X004330-1	NY

General Provider Information

NPI Number	:	1407809155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE MARIE CERULLO D.C.

Provider Business Mailing Address
First Line	:	1342 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3906
Country	:	US
Telephone Number	:	718-720-4030
Fax Number	:	615-468-5683

Provider Business Practice Location Address
First Line	:	1342 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3906
Country	:	US
Telephone Number	:	718-720-4030
Fax Number	:	615-468-5683

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/08/2007

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