Organization
FULTON MEDICAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRIGORIY KRICHMAR D.O. (OWNER)
(631) 271-9151
Entity
Organization
Contact information
Practice address
200 BOUNDARY AVE, STE. 200, MASSAPEQUA, NY 11758-1152
(631) 271-9151
Mailing address
200 BOUNDARY AVE, STE. 200, MASSAPEQUA, NY 11758-1152
(631) 271-9151
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
234331
NY
Other
Enumeration date
05/01/2013
Last updated
05/01/2013
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