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General NPI Number Information
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NPI Number | 1740586833
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Entity Type | Organization
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Legal Business Name | FULTON STREET MEDICAL, PC
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 101 FULTON STREET
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City | FARMINGDALE
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State | NY
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Zip | 11735
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Country | US
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Telephone | 151-575-5585
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Fax |
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Provider Business Mailing Address
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Address Line | 101 FULTON STREET
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City | FARMINGDALE
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State | NY
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Zip | 11735
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Country | US
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Telephone | 151-575-5585
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH ASHLEY
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Credential | MD
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Telephone | 15157555855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 133799
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License Number State | NY
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