MEDICARE: PULAT PULATOV

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	207Q00000X	Family Medicine Physician	281960	NY

General Provider Information

NPI Number	:	1437579166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PULAT PULATOV

Provider Business Mailing Address
First Line	:	6835 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7234
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6835 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7234
Country	:	US
Telephone Number	:	516-354-1600
Fax Number	:

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

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	03/31/2021

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Directions to “ PULAT PULATOV ” Practice Location

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