Individual
DR. NICOLE KULISEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 ARCOLA RD, COLLEGEVILLE, PA 19426-3982
(646) 942-6148
Mailing address
3000 VALLEY FORGE CIR APT 1543, KING OF PRUSSIA, PA 19406-1150
(617) 251-4803
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
249629
NY
2080P0206X
Pediatric Gastroenterology Physician
Primary
248629
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03437845
—
NY
Enumeration date
12/21/2006
Last updated
01/17/2019
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