Provider Demographics
NPI:1215974720
Name:CIULLO, VALENTINO JOSEPH (DPM)
Entity type:Individual
Prefix:DR
First Name:VALENTINO
Middle Name:JOSEPH
Last Name:CIULLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-6206
Mailing Address - Country:US
Mailing Address - Phone:215-755-9339
Mailing Address - Fax:215-755-2389
Practice Address - Street 1:2301 S 13TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3505
Practice Address - Country:US
Practice Address - Phone:215-755-9339
Practice Address - Fax:215-755-2389
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-002159-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0858926-04Medicaid
PA416628Medicare ID - Type Unspecified
PA0858926-04Medicaid
NJ542910Medicare ID - Type Unspecified