| Doctor Name: | ALIX DETULLIO |
| NPI Number: | 1043618747 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | 26NJ00532200 |
| Business Practice Address: | 901 W Main St Freehold, NJ - 077282537 |
| Business Phone Number: | 7324310023 |
| Business Fax Number: | |
| Mailing Address: | 4255 Route 9 N, Suite B FREEHOLD |
| State: | NJ |
| Postal Code: | 077288305 |
| Phone Number: | 7324310023 |
| Fax Number: | |
| NPI Enumeration Date: | 12/11/2014 |
| NPI Last Update Date: | 12/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SA2100X |
| License Number: | 26NJ00532200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |