Individual
DR. JOHN LEWIS FEDULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D. O.
Contact information
Practice address
4988 STATE HIGHWAY 30, AMSTERDAM, NY 12010-7520
(518) 841-3481
Mailing address
4988 STATE HIGHWAY 30, AMSTERDAM, NY 12010-7520
(518) 841-3481
(518) 841-3582
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
197917
NY
208100000X
Physical Medicine & Rehabilitation Physician
Primary
197917
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01762629
—
NY
01
—
1720051428
GROUP NPI
NY
Enumeration date
06/20/2007
Last updated
12/20/2022
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