Individual
MR. MICHAEL KEEN FULLAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
BETH ISRAEL MEDICAL CENTER, 1ST AVE AND 16TH ST, NEW YORK, NY 10003
(212) 844-1543
Mailing address
310 E 24TH ST APT 2E, NEW YORK, NY 10010-4030
(646) 942-6162
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
241619-1
NY
Other
Enumeration date
01/03/2007
Last updated
12/20/2021
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