Healthcare Provider Details

I. General information

NPI: 1427502988
Provider Name (Legal Business Name): ANNE E FULLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 KOSSUTH AVE
BRONX NY
10467-2410
US

IV. Provider business mailing address

3411 WAYNE AVE RM 830
BRONX NY
10467-2509
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2273
  • Fax:
Mailing address:
  • Phone: 718-920-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD455664
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number284754-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: