Peter Anthony Fedullo, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

014433 Issued in NY

Practice address

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

Phone

(212) 305-2500

NPI assigned

Oct 28, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: pef9022@direct.nyp.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288224000000",
    "number": "1275833931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 4TH PL",
            "address_2": "APT 3L",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112313356",
            "telephone_number": "585-727-4387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDULLO",
        "first_name": "PETER",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-28",
        "last_updated": "2010-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "014433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alain Albert Fedida, MD
• Haim Fedida
• Marianna Fedorenko, PHARMD
• David Fedoronko, M.D.
• Anjali K. Fedson Hack, M.D.
• Alexandra Fedurina, LCSW
• Katherine Fee, RN
• Lyndsay Michelle Fee, LCSW
• Robert Joseph Fee, PHD
• Ryan Allen Patrick Feeback, LMSW

• Surgical Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.