Mohawk Valley Physical Medicine and Rehab

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

197917 Issued in NY

Legal business name

MOHAWK VALLEY PHYSICAL MEDICINE AND REHAB

Practice address

4988 State Highway 30
St. Mary'S Hospital Memorial Campus
Amsterdam, NY 12010-7520

Phone

(518) 841-3481

Fax

(518) 841-3481

NPI assigned

Feb 12, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John Lewis Fedullo, D. O.

Title

President

Phone

(518) 841-3481

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1139702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362614400000",
    "number": "1720051428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4988 STATE HIGHWAY 30",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120107520",
            "telephone_number": "518-841-3481",
            "fax_number": "518-841-3582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4988 STATE HIGHWAY 30",
            "address_2": "ST. MARY'S HOSPITAL MEMORIAL CAMPUS",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120107520",
            "telephone_number": "518-841-3481",
            "fax_number": "518-841-3481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAWK VALLEY PHYSICAL MEDICINE AND REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-12",
        "last_updated": "2013-03-07",
        "status": "A",
        "authorized_official_last_name": "FEDULLO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "LEWIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-841-3481",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D. O."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "197917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01762629",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKMANS COMP",
            "identifier": "OPPMR 197917-8",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1538364237",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mohawk Monty
• Mohawk Valley Dialysis Center Inc
• Mohawk Valley Medical Anesthesiology Associates, PLLC
• Mohawk Valley Multispecialty Medical Group PLLC
• Mohawk Valley Orthopedics, P.C.
• Robin H Moller, RN
• Heather Alicia Monge
• Montefiore Medical Center
• Montgomery County Arc
• Montgomery County Arc

• Physical Medicine & Rehabilitation Physician in Amsterdam, NY
• Providers in Amsterdam, NY by specialty
• Physical Medicine & Rehabilitation Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; 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.