Individual
MR. ANTHONY DEMETRIUS FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.N
Contact information
Practice address
44 THE BLVD, AMITYVILLE, NY 11701-1433
(631) 608-8741
Mailing address
44 THE BLVD, AMITYVILLE, NY 11701-1433
(631) 608-8741
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
228275
NY
Other
Enumeration date
04/09/2007
Last updated
07/08/2007
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