Provider Demographics
NPI:1801024856
Name:GRULLON OKUMUS, ARIOLIS CARMELINA (MD)
Entity Type:Individual
Prefix:
First Name:ARIOLIS
Middle Name:CARMELINA
Last Name:GRULLON OKUMUS
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 1:1300 MAIN AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2266
Mailing Address - Country:US
Mailing Address - Phone:973-340-6666
Mailing Address - Fax:
Practice Address - Street 1:1300 MAIN AVE STE 2C
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2266
Practice Address - Country:US
Practice Address - Phone:973-340-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09181100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics