# 24 ON PHYSICIAN NEW YORK, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285799163
- **Authorized official:** DAN FULLER (PRESIDENT)
- **Authorized official phone:** (770) 740-0895

## Contact information

- **Practice address:** 101 DATES DR, ITHACA, NY 14850-1342
- **Practice address phone:** (607) 274-4191
- **Practice address fax:** (607) 274-4198
- **Mailing address:** PO BOX 403631, ATLANTA, GA 30384-3631
- **Mailing address phone:** (770) 740-0895
- **Mailing address fax:** (770) 740-0896

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/22/2006
- **Last updated:** 08/22/2020