Provider Demographics
NPI:1164872875
Name:FANCIULLI, FLORENS
Entity Type:Individual
Prefix:
First Name:FLORENS
Middle Name:
Last Name:FANCIULLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E 14TH ST
Mailing Address - Street 2:APT. 8D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4208
Mailing Address - Country:US
Mailing Address - Phone:917-407-6845
Mailing Address - Fax:
Practice Address - Street 1:333 E 14TH ST
Practice Address - Street 2:APT. 8D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4208
Practice Address - Country:US
Practice Address - Phone:917-407-6845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist