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Individual

MISS JENNIFER FULTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
285 SILLS RD, E PATCHOGUE, NY 11772-4869
(631) 447-8300
Mailing address
951 ROANOKE AVE, RIVERHEAD, NY 11901-2724
(631) 727-7773
(631) 727-7832

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
009370
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02519684
NY
Enumeration date
10/24/2005
Last updated
08/11/2022
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