MEDICARE: FOUNTAIN PULMONARY P.C

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	207RP1001X	Pulmonary Disease Physician	212276	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902816051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNTAIN PULMONARY P.C

Provider Business Mailing Address
First Line	:	800 MANOR RD
Second Line	:	SUITE 3
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-7034
Country	:	US
Telephone Number	:	347-562-2753
Fax Number	:	347-289-5100

Provider Business Practice Location Address
First Line	:	800 MANOR RD
Second Line	:	SUITE 3
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-7034
Country	:	US
Telephone Number	:	347-562-2753
Fax Number	:	347-289-5100

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ADEBAMBO DOLAPO OLAJITAN
Credential	:	M.D., FCCP
Telephone Number	:	347-562-2753

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/16/2010

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Practice Location Address:

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1942402722 — DR. FILIPPO S RAGONE D.C.
Practice Location Address:

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