Provider Demographics
NPI:1902974314
Name:KULLER, MARY EHRLICH (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EHRLICH
Last Name:KULLER
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:AUGUSTA
Other - Last Name:EHRLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:51 W 51ST ST
Mailing Address - Street 2:SUITE 385
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6113
Mailing Address - Country:US
Mailing Address - Phone:212-326-8475
Mailing Address - Fax:212-326-8585
Practice Address - Street 1:51 W 51ST ST
Practice Address - Street 2:SUITE 385
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6113
Practice Address - Country:US
Practice Address - Phone:212-326-8475
Practice Address - Fax:212-326-8585
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000111-1231H00000X
NY14000004697237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400003333Medicare PIN