Provider Demographics
NPI:1316002322
Name:ARTIS, FULESIE GRAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:FULESIE
Middle Name:GRAY
Last Name:ARTIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1818
Mailing Address - Country:US
Mailing Address - Phone:973-778-4943
Mailing Address - Fax:973-778-4943
Practice Address - Street 1:17 RUTH AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1818
Practice Address - Country:US
Practice Address - Phone:973-778-4943
Practice Address - Fax:973-778-4943
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002535213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1499599OtherGHI PPO
NJ9017909Medicaid
NJ3550373OtherCIGNA
NJ089140Medicare ID - Type UnspecifiedMEDICARE ID#
NJ9017909Medicaid