Individual
MR. PETER ANTHONY FEDULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(212) 305-2500
Mailing address
11 4TH PL, APT 3L, BROOKLYN, NY 11231-3356
(585) 727-4387
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
014433
NY
Other
Enumeration date
10/28/2010
Last updated
10/28/2010
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