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General NPI Number Information
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NPI Number | 1336043702
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Entity Type | Organization
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Legal Business Name | NYC RUNNING DOC LLC
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 25 CENTRAL PARK W APT 1R
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City | NEW YORK
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State | NY
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Zip | 10023-7214
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Country | US
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Telephone | 646-267-1075
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Fax |
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Provider Business Mailing Address
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Address Line | 25 CENTRAL PARK W APT 1R
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City | NEW YORK
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State | NY
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Zip | 10023-7214
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Country | US
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Telephone | 646-267-1075
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DR BRIAN WILLIAM FULLEM
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Credential | DPM
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Telephone | 646-267-1075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number |
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License Number State | NULL
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