Healthcare Provider Details

I. General information

NPI: 1578781787
Provider Name (Legal Business Name): 24 ON PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 BEACH 19TH ST
FAR ROCKAWAY NY
11691-4423
US

IV. Provider business mailing address

PO BOX 19108
BELFAST ME
04915-4086
US

V. Phone/Fax

Practice location:
  • Phone: 770-740-0895
  • Fax:
Mailing address:
  • Phone: 770-740-0895
  • Fax: 404-806-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN FULLER
Title or Position: SECRETARY
Credential:
Phone: 770-740-0895