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NPI Code Detail

MEDICARE: DR. STAVRULA G. FASULI M.D.

MEDICARE: DR. STAVRULA G. FASULI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician138225NY

General Provider Information

NPI Number : 1487608899
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STAVRULA G. FASULI M.D.
Provider Business Mailing Address
First Line : 3175 23RD ST
Second Line :
City : ASTORIA
State : NY
Zip : 11106-4134
Country : US
Telephone Number : 718-956-2200
Fax Number : 718-956-2316
Provider Business Practice Location Address
First Line : 3175 23RD ST
Second Line :
City : ASTORIA
State : NY
Zip : 11106-4134
Country : US
Telephone Number : 718-956-2200
Fax Number : 718-956-2316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 07/08/2007

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