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 1:715 CRAIG AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-1511
Mailing Address - Country:US
Mailing Address - Phone:917-750-7786
Mailing Address - Fax:347-695-2401
Practice Address - Street 1:4300 HYLAN BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6505
Practice Address - Country:US
Practice Address - Phone:347-559-1254
Practice Address - Fax:347-695-2401
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0056461133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered