Individual
MR. MANUEL I ULLOA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
1727 AMSTERDAM AVE, NEW YORK, NY 10031-4611
(212) 694-9200
Mailing address
73 HARRIS AVE, HEWLETT, NY 11557-1309
(516) 569-8490
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12905
NY
Other
Enumeration date
04/23/2007
Last updated
11/05/2007
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