Provider Demographics
NPI:1144582032
Name:PULLIAM, DORIS L (MS)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:L
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110-17 197 STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412
Mailing Address - Country:US
Mailing Address - Phone:718-528-9609
Mailing Address - Fax:
Practice Address - Street 1:83 MARLBOROUGH ROAD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226
Practice Address - Country:US
Practice Address - Phone:718-528-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist