Provider Demographics
NPI:1891901682
Name:GULOTTA, MEGAN (MSN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:GULOTTA
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FORT WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6849
Mailing Address - Country:US
Mailing Address - Phone:212-923-8550
Mailing Address - Fax:212-568-1163
Practice Address - Street 1:400 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6849
Practice Address - Country:US
Practice Address - Phone:212-923-8550
Practice Address - Fax:212-568-1163
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420788207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF420788OtherLICENCE NUMBER