Provider Demographics
NPI:1457650210
Name:KULINA, GEORGIA (MD)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:KULINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OAKLAND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2130
Mailing Address - Country:US
Mailing Address - Phone:631-978-7590
Mailing Address - Fax:631-686-2552
Practice Address - Street 1:125 OAKLAND AVE STE 203
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-978-7590
Practice Address - Fax:631-686-2552
Is Sole Proprietor?:No
Enumeration Date:2011-03-19
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270727207R00000X, 207RE0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program