Provider Demographics
NPI:1043272701
Name:GULEKSEN AL-SULLAMI, KRISTEN MARIE (MSPT)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:MARIE
Last Name:GULEKSEN AL-SULLAMI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 JERICHO TPKE
Mailing Address - Street 2:STE. 235
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-682-8560
Mailing Address - Fax:516-682-8562
Practice Address - Street 1:68651 JERICHO TPKE
Practice Address - Street 2:STE 235
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-682-8560
Practice Address - Fax:516-682-8562
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022061225100000X
NY022061-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL2381Medicare ID - Type Unspecified