MEDICARE: DR. ROBERT FULOP

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
1	207R00000X	Internal Medicine Physician	138475	NY

General Provider Information

NPI Number	:	1861461345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT FULOP

Provider Business Mailing Address
First Line	:	476 KLONDIKE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-6216
Country	:	US
Telephone Number	:	718-761-1156
Fax Number	:	718-761-1047

Provider Business Practice Location Address
First Line	:	476 KLONDIKE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-6216
Country	:	US
Telephone Number	:	718-761-1156
Fax Number	:	718-761-1047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/08/2007

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