Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MA53726 | NJ |
NPI | 1023048584 |
---|---|
Provider Name | Dr. Holly Cullen |
First Address | Emerson, NJ 07630-1396 |
Second Address | Emerson, NJ 07630-1396 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 21/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F41299 | (02) | NJ |