Healthcare Provider Details

I. General information

NPI: 1467616474
Provider Name (Legal Business Name): JACQUELINE I FULOP DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E 37TH ST APT 43C
NEW YORK NY
10016-3249
US

IV. Provider business mailing address

415 E 37TH ST APT 43C
NEW YORK NY
10016-3249
US

V. Phone/Fax

Practice location:
  • Phone: 212-972-3522
  • Fax: 646-606-3284
Mailing address:
  • Phone: 212-972-3522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN046762
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: