Provider Demographics
NPI:1821309642
Name:CORIATY-HULLA, CARLA A (CDN)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:CORIATY-HULLA
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 RICHMOND AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3831
Mailing Address - Country:US
Mailing Address - Phone:917-750-7786
Mailing Address - Fax:347-695-2401
Practice Address - Street 1:3845 RICHMOND AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3831
Practice Address - Country:US
Practice Address - Phone:917-750-7786
Practice Address - Fax:347-559-1254
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0056461133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered