# MOHAWK VALLEY PHYSICAL MEDICINE AND REHAB

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

## Provider details

- **NPI number:** 1720051428
- **Authorized official:** DR. JOHN LEWIS FEDULLO D. O. (PRESIDENT)
- **Authorized official phone:** (518) 841-3481

## Contact information

- **Practice address:** 4988 STATE HIGHWAY 30, ST. MARY'S HOSPITAL MEMORIAL CAMPUS, AMSTERDAM, NY 12010-7520
- **Practice address phone:** (518) 841-3481
- **Practice address fax:** (518) 841-3481
- **Mailing address:** 4988 STATE HIGHWAY 30, AMSTERDAM, NY 12010-7520
- **Mailing address phone:** (518) 841-3481
- **Mailing address fax:** (518) 841-3582

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 197917 | NY | Yes |

## Other

- **Enumeration date:** 02/12/2006
- **Last updated:** 03/07/2013