Organization
TRUC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND FULLERTON (MEMBER)
(917) 583-5499
Entity
Organization
Contact information
Practice address
66 BROAD ST UNIT D, STAMFORD, CT 06901-2314
(917) 583-5499
Mailing address
800 WESTCHESTER AVE STE N641, RYE BROOK, NY 10573-1360
(917) 583-5499
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
05/28/2025
Last updated
05/28/2025
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