NPIMap

Organization Active NPI

Nulton Diagnostic & Treatment Center, PC

  • Neurodevelopmental Disabilities Physician
  • Johnstown, PA
National Provider Identifier
1073573010
Registry record updated Jun 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurodevelopmental Disabilities PhysicianTaxonomy code 2084P0005X
Legal business name
NULTON DIAGNOSTIC & TREATMENT CENTER, PC
Practice address
214 College Park PLZ
Johnstown, PA 15904-2833
Phone
(814) 262-0025
Fax
(814) 266-8745
NPI assigned
Mar 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Larry J NultonNPI 1497896906
Title
Owner
Phone
(814) 262-0025

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Neurodevelopmental Disabilities PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0005X Primary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Community/Behavioral Health Agency 251S00000X 314080 PA
Community/Behavioral Health Agency 251S00000X 117055 PA

Addresses

Primary practice location

214 College Park PLZ
Johnstown, PA 15904-2833

Mailing address

214 College Park PLZ
Johnstown, PA 15904-2833
Phone (814) 262-0025

Other practice location 1

321 Main St Ste 4F
Johnstown, PA 15901-1632
Phone (814) 254-4905

Other identifiers 1

IdentifierTypeStateIssuer
1007324900011MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040225000665 PA Part B Supplier - Clinic/Group Practice 5294621363 Receives reassigned benefits from 54 practitioners
1 other NPI on this enrollment
Practice locations: Johnstown, PA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2086877Nulton Diagnostic & Treatment Center214 College Park Plaza, Johnstown, PA 15904Certificate of waiverNov 12, 2026

National Provider Directory

National Provider Directory

Locations

132 Walnut St
Johnstown, PA 15901
Phone (814) 535-7570

Practitioners & affiliated clinicians

Practitioners 56

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 56

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780963200000",
    "number": "1073573010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 COLLEGE PARK PLZ",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159042833",
            "telephone_number": "814-262-0025",
            "fax_number": "814-266-8745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 COLLEGE PARK PLZ",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159042833",
            "telephone_number": "814-262-0025",
            "fax_number": "814-266-8745"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "321 Main St Ste 4F",
            "address_purpose": "LOCATION",
            "city": "Johnstown",
            "state": "PA",
            "postal_code": "159011632",
            "country_code": "US",
            "telephone_number": "814-254-4905",
            "fax_number": "814-266-2880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NULTON DIAGNOSTIC & TREATMENT CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-24",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A",
        "authorized_official_last_name": "NULTON",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-262-0025"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurodevelopmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "314080",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "117055",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007324900011",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnstown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.