MEDICARE: DR. MANUEL CASULLA HUGO M.D.

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	174400000X	Specialist	25MA03558400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760568836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL CASULLA HUGO M.D.

Provider Business Mailing Address
First Line	:	2009 PALISADE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4429
Country	:	US
Telephone Number	:	201-865-6750
Fax Number	:	201-601-1336

Provider Business Practice Location Address
First Line	:	2009 PALISADE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4429
Country	:	US
Telephone Number	:	201-865-6750
Fax Number	:	201-601-1336

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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