Individual provider Active NPI

Christina Marie Gulla

  • Pediatrics Physician
  • Hackensack, NJ
National Provider Identifier
1427635697
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MB12161300 Issued in NJ
Practice address
30 Prospect Ave
Hackensack, NJ 07601-1915
Phone
(551) 996-2000
NPI assigned
Mar 25, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 25MB12161300 NJ Primary

Addresses

Primary practice location

30 Prospect Ave
Hackensack, NJ 07601-1915

Mailing address

15 Park West Dr
Mountainside, NJ 07092-2733
Phone (908) 477-8089

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
25MB12161300NJMDPediatrics Physician

NPI Registry JSON

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

{
    "created_epoch": "1616630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1427635697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PARK WEST DR",
            "city": "MOUNTAINSIDE",
            "state": "NJ",
            "postal_code": "070922733",
            "telephone_number": "908-477-8089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 PROSPECT AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011915",
            "telephone_number": "551-996-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLA",
        "first_name": "CHRISTINA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-25",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MB12161300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.