Provider Demographics
NPI:1386025633
Name:FUCANCER
Entity Type:Organization
Organization Name:FUCANCER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOYA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:347-248-9323
Mailing Address - Street 1:3605 VERNON BLVD
Mailing Address - Street 2:APT 2R
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-5188
Mailing Address - Country:US
Mailing Address - Phone:347-248-9323
Mailing Address - Fax:
Practice Address - Street 1:3605 VERNON BLVD
Practice Address - Street 2:APT 2R
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-5188
Practice Address - Country:US
Practice Address - Phone:347-248-9323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY593167251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care