Provider Demographics
NPI:1386646248
Name:PULLMAN, MADELYN D (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELYN
Middle Name:D
Last Name:PULLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1551 RICHMOND ROAD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2313
Mailing Address - Country:US
Mailing Address - Phone:718-987-5330
Mailing Address - Fax:718-987-5437
Practice Address - Street 1:1551 RICHMOND ROAD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2313
Practice Address - Country:US
Practice Address - Phone:718-987-5330
Practice Address - Fax:718-987-5437
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY122312207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00230153Medicaid
NY00230153Medicaid
NYB12734Medicare UPIN