Provider Demographics
NPI:1619114741
Name:PAUL F FULFORD PHD PA
Entity Type:Organization
Organization Name:PAUL F FULFORD PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:FULFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-278-1203
Mailing Address - Street 1:100 HAMILTON PLZ
Mailing Address - Street 2:SUITE 1411
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-2109
Mailing Address - Country:US
Mailing Address - Phone:973-278-1203
Mailing Address - Fax:
Practice Address - Street 1:100 HAMILTON PLZ
Practice Address - Street 2:SUITE 1411
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-2109
Practice Address - Country:US
Practice Address - Phone:973-278-1203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00177400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty