Individual
ALEXANDER FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
21 EASTPORT MANOR RD, EASTPORT, NY 11941-1410
(631) 325-2255
(631) 325-8562
Mailing address
25 RICHIE CT N, SAINT JAMES, NY 11780-3151
(631) 793-0971
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
10/15/2019
Last updated
10/15/2019
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