Provider Demographics
NPI:1750307211
Name:FUKILMAN, OSCAR JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:JORGE
Last Name:FUKILMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25-31 30TH ROAD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2648
Mailing Address - Country:US
Mailing Address - Phone:718-267-1102
Mailing Address - Fax:718-267-0847
Practice Address - Street 1:25-31 30TH ROAD
Practice Address - Street 2:SUITE 1A
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2648
Practice Address - Country:US
Practice Address - Phone:718-267-1102
Practice Address - Fax:718-267-0847
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00199739Medicaid
NY00199739Medicaid
NY03257Medicare PIN