1063944494 NPI number — BROOKS JARED CULOTTA MD

Table of content: ANNIE SALVATORE (NPI 1013535962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063944494 NPI number — BROOKS JARED CULOTTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CULOTTA
Provider First Name:
BROOKS
Provider Middle Name:
JARED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063944494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 POYDRAS ST., 2500 ENERGY CENTRE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70163-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-527-9953
Provider Business Mailing Address Fax Number:
504-527-9950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4224 HOUMA BLVD STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006-2934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-503-6565
Provider Business Practice Location Address Fax Number:
504-456-8053
Provider Enumeration Date:
04/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  322287 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 322287 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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