Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208C00000X | Colorectal Surgeon | 250373-1 | NY |
NPI | 1992965974 |
---|---|
Provider Name | Mychailo Fulmes |
First Address | Astoria, NY 11102-2242 |
Second Address | Brooklyn, NY 11223-5502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 04/04/2013 |