Provider Demographics
NPI:1629018734
Name:CULLITON, PHILLIP C (DPM)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:C
Last Name:CULLITON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-9462
Mailing Address - Country:US
Mailing Address - Phone:716-835-2617
Mailing Address - Fax:716-835-5865
Practice Address - Street 1:2700 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9462
Practice Address - Country:US
Practice Address - Phone:716-835-2617
Practice Address - Fax:716-835-5865
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003003213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00687590Medicaid
NYT26060Medicare UPIN
NYPC078511Medicare ID - Type Unspecified