Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Larry D McCullum

Individual provider Physician Assistant · NPI 1669351896

Larry D McCullum is a Physician Assistant in Green Brook, New Jersey. Qualified in 2023, 3 years ago. Accepts Medicare assignment.

Years since qualifying
3
In the registry since
2025

Practice location Address checks out

1005 N Washington Ave
Green Brook, NJ 08812
Phone: (732) 968-8900
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1669351896
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 1, 2025
Last updated in NPPESJanuary 21, 2026
Certification dateJanuary 21, 2026
Mailing address62 Morris Lane, Piscataway, NJ 08854

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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