Organization
MOHAWK VALLEY PHYSICAL MEDICINE AND REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN LEWIS FEDULLO D. O. (PRESIDENT)
(518) 841-3481
Entity
Organization
Contact information
Practice address
4988 STATE HIGHWAY 30, ST. MARY'S HOSPITAL MEMORIAL CAMPUS, AMSTERDAM, NY 12010-7520
(518) 841-3481
(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
208100000X
Physical Medicine & Rehabilitation Physician
Primary
197917
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01762629
—
NY
01
—
1538364237
INDIVIDUAL NPI
NY
01
—
OPPMR 197917-8
WORKMANS COMP
NY
Enumeration date
02/12/2006
Last updated
03/07/2013
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