Provider Demographics
NPI:1790573400
Name:LARRY, KULSUM (MD)
Entity type:Individual
Prefix:
First Name:KULSUM
Middle Name:
Last Name:LARRY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 HALSTED ST APT 204
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3587
Mailing Address - Country:US
Mailing Address - Phone:917-564-1321
Mailing Address - Fax:
Practice Address - Street 1:185 SOUTH ORANGE AVE MEDICAL SCIENCE BUILDING
Practice Address - Street 2:SUITE G595
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program