Provider Demographics
NPI:1346377504
Name:CULLEN, JAMES MICHAEL (PHD, PT)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:CULLEN
Suffix:
Gender:M
Credentials:PHD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KENNEDY PKWY
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1410
Mailing Address - Country:US
Mailing Address - Phone:607-753-1055
Mailing Address - Fax:607-753-1099
Practice Address - Street 1:8 KENNEDY PKWY
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1410
Practice Address - Country:US
Practice Address - Phone:607-753-1055
Practice Address - Fax:607-753-1099
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY889503OtherAETNA
NY6699643OtherGHI
NY01240317Medicaid
NY698740OtherMVP
NY53926BMedicare ID - Type Unspecified