Individual
IVY NICOLE TUELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1275 YORK AVE, NEW YORK, NY 10065-6007
(212) 639-2000
Mailing address
3 CENTER ST FL 2, PLEASANTVILLE, NY 10570-3101
(801) 541-9899
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
022776
NY
Other
Enumeration date
09/11/2018
Last updated
01/26/2021
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