Provider Demographics
NPI:1881843639
Name:GLENCOVE OBGYN ASSOCIATES
Entity Type:Organization
Organization Name:GLENCOVE OBGYN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:THURMAN
Authorized Official - Last Name:FULMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:516-671-5197
Mailing Address - Street 1:50 SCHOOL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2534
Mailing Address - Country:US
Mailing Address - Phone:516-671-5197
Mailing Address - Fax:516-671-5231
Practice Address - Street 1:50 SCHOOL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2534
Practice Address - Country:US
Practice Address - Phone:516-671-5197
Practice Address - Fax:516-671-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113417207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB20390Medicare UPIN
NY955921Medicare PIN