Provider Demographics
NPI:1265629497
Name:GULIAN, AUDREY LONGID (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LONGID
Last Name:GULIAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2419
Mailing Address - Country:US
Mailing Address - Phone:718-275-3661
Mailing Address - Fax:516-568-7912
Practice Address - Street 1:57 BROOK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-2419
Practice Address - Country:US
Practice Address - Phone:718-275-3661
Practice Address - Fax:516-568-7912
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014692-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06651Medicare UPIN