MEDICARE: JANE CULLEY

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	225700000X	Massage Therapist	026250-1	NY
2	171100000X	Acupuncturist	004847-1	NY

General Provider Information

NPI Number	:	1487108429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE CULLEY

Provider Business Mailing Address
First Line	:	300 E 40TH ST
Second Line	:	APT. 6B
City	:	NEW YORK
State	:	NY
Zip	:	10016-2188
Country	:	US
Telephone Number	:	917-913-1903
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E 40TH ST
Second Line	:	APT. 6B
City	:	NEW YORK
State	:	NY
Zip	:	10016-2188
Country	:	US
Telephone Number	:	917-913-1903
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JANE CULLEY
Credential	:	LAC,
Telephone Number	:	917-913-1903

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	08/08/2016

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