Individual
ASIAJ C TULLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2907 SIPP AVE, MEDFORD, NY 11763-1984
(631) 428-0666
Mailing address
2907 SIPP AVE, MEDFORD, NY 11763-1984
(631) 428-0666
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
341460
NY
Other
Enumeration date
06/26/2021
Last updated
06/26/2021
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