Individual provider · Type 1 NPI

Peter Anthony Fedullo, PA

Surgical Physician Assistant · New York, NY

NPI number 1275833931 Active

Practice location

622 W 168th St
New York, NY 10032-3720

Call (212) 305-2500 Map

Mailing address

11 4th Pl, Apt 3L
Brooklyn, NY 11231-3356

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400X014433 (NY)

Surgical Physician Assistant: Definition to come...

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About NPI 1275833931

Peter Anthony Fedullo, PA's National Provider Identifier is 1275833931, issued on Oct 28, 2010. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in New York, NY. The record was last updated on Oct 28, 2010.