| Doctor Name: | ALISA G. CULLEN |
| NPI Number: | 1003954074 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 25MP00091800 |
| Business Practice Address: | 745 Northfield Ave Suite 4 West Orange, NJ - 070521144 |
| Business Phone Number: | 9737360041 |
| Business Fax Number: | 9737360044 |
| Mailing Address: | 745 Northfield Ave, Suite 4 WEST ORANGE |
| State: | NJ |
| Postal Code: | 070521144 |
| Phone Number: | 9737360041 |
| Fax Number: | 9737360044 |
| NPI Enumeration Date: | 02/02/2007 |
| NPI Last Update Date: | 12/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 25MP00091800 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |