Basic Information
| Provider Information | |||||||||
| NPI: | 1689602864 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PULLI | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 629 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857585700 | ||||||||
| FaxNumber: | 5857581293 | ||||||||
| Practice Location | |||||||||
| Address1: | 2365 S CLINTON AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857585700 | ||||||||
| FaxNumber: | 5857581293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 03/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 186661 | NY | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | P02018661 | 01 | NY | BLUE SHIELD | OTHER | 5456538 | 01 | NY | AETNA | OTHER | 9715327 | 01 | NY | GHI | OTHER | P010186661 | 01 | NY | BLUE CHOICE | OTHER | 00524735005 | 01 | NM | COMMUNITY BLUE | OTHER | MDH269 | 01 | NY | PREFERRED CARE | OTHER | 01747584 | 05 | NY | MEDICAID |