Provider Demographics
NPI:1730404823
Name:MCCULLOUGH, APRIL JUNENE (MD)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:JUNENE
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:APRIL
Other - Middle Name:JUNENE
Other - Last Name:IHLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:110 FISHER AVE APT 4G
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-2621
Mailing Address - Country:US
Mailing Address - Phone:517-819-5305
Mailing Address - Fax:
Practice Address - Street 1:1150 BRIGHTON BEACH AVE APT 1Y
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5954
Practice Address - Country:US
Practice Address - Phone:718-332-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09523500207W00000X
NY271385207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology