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Individual

KENNETH MCCULLOCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
6336 99TH ST, REGO PARK, NY 11374-1979
(718) 275-1919
(718) 275-1955
Mailing address
6336 99TH ST, REGO PARK, NY 11374-1979
(718) 275-1919
(718) 275-1955

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
220173
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02880679
NY
Enumeration date
07/29/2005
Last updated
01/15/2014
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