MEDICARE: EMMANUEL M KULLIE

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	106S00000X	Behavior Technician
2	3747A0650X	Attendant Care Provider
3	343900000X	Non-emergency Medical Transport (VAN)	K92202257409922	NJ
4	347C00000X	Private Vehicle	K92202257409922	NJ

General Provider Information

NPI Number	:	1912730953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL M KULLIE

Provider Business Mailing Address
First Line	:	185 GLENWOOD AVE
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-2009
Country	:	US
Telephone Number	:	973-687-8356
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 GLENWOOD AVE
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-2009
Country	:	US
Telephone Number	:	973-687-8356
Fax Number	:

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

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/23/2024

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Directions to “ EMMANUEL M KULLIE ” Practice Location

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