Provider Demographics
NPI:1679515233
Name:FULMAN, STELLA (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:STELLA
Middle Name:
Last Name:FULMAN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 OLDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5009
Mailing Address - Country:US
Mailing Address - Phone:718-757-9658
Mailing Address - Fax:
Practice Address - Street 1:148 NEW DORP LN
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3004
Practice Address - Country:US
Practice Address - Phone:718-980-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002031231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM75561Medicare PIN