NPIMap

Organization Active NPI

Fulton Medical, P.C.

  • Internal Medicine Physician
  • Massapequa, NY
National Provider Identifier
1841635133
Registry record updated May 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
234331 Issued in NY
Legal business name
FULTON MEDICAL, P.C.
Practice address
200 Boundary Ave
Ste. 200
Massapequa, NY 11758-1152
Phone
(631) 271-9151
NPI assigned
May 1, 2013
Last updated
May 1, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2013

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

Authorized official

Name
Grigoriy Krichmar, D.O.NPI 1043371164
Title
Owner
Phone
(631) 271-9151

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 234331 NY Primary

Addresses

Primary practice location

200 Boundary Ave
Ste. 200
Massapequa, NY 11758-1152

Mailing address

200 Boundary Ave
Ste. 200
Massapequa, NY 11758-1152
Phone (631) 271-9151

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130823000424 NY Part B Supplier - Clinic/Group Practice 8527201540 Receives reassigned benefits from 41 practitioners
Practice locations: Syosset, NY

National Provider Directory

National Provider Directory

Locations

60 Queens St
Ste 100
Syosset, NY 11791
Phone (347) 267-0904

Practitioners & affiliated clinicians

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367366400000",
    "number": "1841635133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BOUNDARY AVE",
            "address_2": "STE. 200",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117581152",
            "telephone_number": "631-271-9151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BOUNDARY AVE",
            "address_2": "STE. 200",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117581152",
            "telephone_number": "631-271-9151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULTON MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-01",
        "last_updated": "2013-05-01",
        "status": "A",
        "authorized_official_last_name": "KRICHMAR",
        "authorized_official_first_name": "GRIGORIY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-271-9151",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "234331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Massapequa, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.