Healthcare Provider Details

I. General information

NPI: 1427896653
Provider Name (Legal Business Name): FUEL MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MEADOWLANDS PKWY
SECAUCUS NJ
07094-2311
US

IV. Provider business mailing address

672 DOGWOOD AVE STE 404
FRANKLIN SQUARE NY
11010-3247
US

V. Phone/Fax

Practice location:
  • Phone: 347-813-0535
  • Fax:
Mailing address:
  • Phone: 347-813-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN PHILLIPS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 347-813-0535