Provider Demographics
NPI:1174709190
Name:ROBERT FULOP, M.D., P.C.
Entity type:Organization
Organization Name:ROBERT FULOP, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FULOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-761-1156
Mailing Address - Street 1:476 KLONDIKE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6216
Mailing Address - Country:US
Mailing Address - Phone:718-761-1156
Mailing Address - Fax:
Practice Address - Street 1:476 KLONDIKE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6216
Practice Address - Country:US
Practice Address - Phone:718-761-1156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEX721Medicare PIN