Individual
GRACE NABILA PENA FATULE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8900 VAN WYCK EXPY, JAMAICA, NY 11418-2832
(210) 206-6000
Mailing address
8900 VAN WYCK EXPY, JAMAICA, NY 11418-2832
(718) 206-6000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
307883-01
NY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
307883-01
NY
207RP1001X
Pulmonary Disease Physician
307883-01
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
04/12/2016
Last updated
07/24/2024
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