Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 25MA09479000 | NJ |
NPI | 1053585232 |
---|---|
Provider Name | Christopher Michael Tully |
First Address | Mountain Lakes, NJ 07046-1743 |
Second Address | Mountain Lakes, NJ 07046-1743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 28/06/2017 |