Provider Demographics
NPI:1982827291
Name:ZULLI, ALAN DEAN (RN)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:DEAN
Last Name:ZULLI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SIMEON RD
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-5414
Mailing Address - Country:US
Mailing Address - Phone:631-722-5229
Mailing Address - Fax:
Practice Address - Street 1:EAST END CLINIC
Practice Address - Street 2:300 CENTER DRIVE
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-0000
Practice Address - Country:US
Practice Address - Phone:631-852-2680
Practice Address - Fax:631-852-2674
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY474301-1163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)