Provider Demographics
NPI:1013198787
Name:PULEO, PETER J (DC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:PULEO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 LIGHTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-4305
Mailing Address - Country:US
Mailing Address - Phone:516-781-4811
Mailing Address - Fax:
Practice Address - Street 1:2566 NELSON DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-3615
Practice Address - Country:US
Practice Address - Phone:516-781-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007036-3111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX63052Medicare PIN