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NPI Code Detail

MEDICARE: CORY ULLGER D.O.

MEDICARE: CORY ULLGER D.O.
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
12081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician300596NY

General Provider Information

NPI Number : 1720441660
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORY ULLGER D.O.
Provider Business Mailing Address
First Line : 3825 ASTORIA BLVD
Second Line :
City : ASTORIA
State : NY
Zip : 11103-3608
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3825 ASTORIA BLVD
Second Line :
City : ASTORIA
State : NY
Zip : 11103-3608
Country : US
Telephone Number : 718-274-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2016
Last Update Date : 09/18/2024

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Directions to “ CORY ULLGER D.O.” Practice Location

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