Provider Demographics
NPI:1548243876
Name:RULLI, GEORGE (DC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:RULLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 HOLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4100
Mailing Address - Country:US
Mailing Address - Phone:631-471-2225
Mailing Address - Fax:631-471-4814
Practice Address - Street 1:158 HOLBROOK RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4100
Practice Address - Country:US
Practice Address - Phone:631-471-2225
Practice Address - Fax:631-471-4814
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003984-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52662Medicare UPIN
NYX22321Medicare ID - Type Unspecified