Provider Demographics
NPI:1912449687
Name:ELLEN M TULLY ASSOCIATES INC
Entity type:Organization
Organization Name:ELLEN M TULLY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-510-8266
Mailing Address - Street 1:740 E BROADWAY
Mailing Address - Street 2:5N
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4759
Mailing Address - Country:US
Mailing Address - Phone:516-510-8266
Mailing Address - Fax:516-431-3474
Practice Address - Street 1:740 E BROADWAY
Practice Address - Street 2:5N
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4759
Practice Address - Country:US
Practice Address - Phone:516-510-8266
Practice Address - Fax:516-431-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-13
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8015252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency