Active NPI
Michael Jay Tullman, DDS
- Dentist
- Philadelphia, PA
National Provider Identifier
1407014889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS020814L
- Practice address
- 732-4 South 8TH Street
Philadelphia, PA 19147 - Phone
- (215) 440-0133
- NPI assigned
- Jun 2, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS020814L | PA | Primary |
Addresses
Primary practice location
732-4 South 8TH Street
Philadelphia, PA 19147
Mailing address
732-4 South 8TH Street
Philadelphia, PA 19147
Phone (215) 440-0133
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160524000031 | PA | Order and Referring Only - Dentist | 7618266198 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212364800000",
"number": "1407014889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "732-4 SOUTH 8TH STREET",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19147",
"telephone_number": "215-440-0133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "732-4 SOUTH 8TH STREET",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19147",
"telephone_number": "215-440-0133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TULLMAN",
"first_name": "MICHAEL",
"middle_name": "JAY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-02",
"last_updated": "2008-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS020814L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.