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General NPI Number Information
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NPI Number | 1083984090
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Entity Type | Organization
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Legal Business Name | GOLDKLANK & FULMER PSYCHOLOGICAL SERVICES PC
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 740 W END AVE
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City | NEW YORK
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State | NY
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Zip | 10025-6246
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Country | US
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Telephone | 212-222-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 740 W END AVE
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City | NEW YORK
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State | NY
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Zip | 10025-6246
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Country | US
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Telephone | 212-222-7084
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. RICHARD H. FULMER
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Credential | PH.D.
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Telephone | 212-222-7084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4895
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License Number State | NY
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