Provider Demographics
NPI:1720314743
Name:PULIS, GERALD ALLEN JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ALLEN
Last Name:PULIS
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:29 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NAPANOCH
Mailing Address - State:NY
Mailing Address - Zip Code:12458-2810
Mailing Address - Country:US
Mailing Address - Phone:845-741-5339
Mailing Address - Fax:718-322-6836
Practice Address - Street 1:29 HIGH ST
Practice Address - Street 2:
Practice Address - City:NAPANOCH
Practice Address - State:NY
Practice Address - Zip Code:12458-2810
Practice Address - Country:US
Practice Address - Phone:845-741-5339
Practice Address - Fax:718-322-6836
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY019472225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist