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Organization
24 ON PHYSICIAN NEW YORK, PC
Active
Organization
24 ON PHYSICIAN NEW YORK, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN FULLER (PRESIDENT)
(770) 740-0895
Entity
Organization
Contact information
Practice address
101 DATES DR, ITHACA, NY 14850-1342
(607) 274-4191
(607) 274-4198
Mailing address
PO BOX 403631, ATLANTA, GA 30384-3631
(770) 740-0895
(770) 740-0896
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
12/22/2006
Last updated
08/22/2020
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