Provider Demographics
NPI:1073923561
Name:COLORECTAL CARE PLLC
Entity Type:Organization
Organization Name:COLORECTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:MYCHAILO
Authorized Official - Middle Name:
Authorized Official - Last Name:FULMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-743-4450
Mailing Address - Street 1:7000 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5531
Mailing Address - Country:US
Mailing Address - Phone:718-743-4450
Mailing Address - Fax:
Practice Address - Street 1:2647 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5502
Practice Address - Country:US
Practice Address - Phone:718-743-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty