Provider Demographics
NPI:1891877593
Name:FULMAN, MALVINA (MD)
Entity Type:Individual
Prefix:
First Name:MALVINA
Middle Name:
Last Name:FULMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176-60 UNION TURNPIKE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1531
Mailing Address - Country:US
Mailing Address - Phone:718-460-2300
Mailing Address - Fax:347-225-9930
Practice Address - Street 1:176-60 UNION TURNPIKE
Practice Address - Street 2:SUITE 360
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1531
Practice Address - Country:US
Practice Address - Phone:718-460-2300
Practice Address - Fax:347-225-9930
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205686-1174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01878019Medicaid
NY01878019Medicaid
NYG68999Medicare UPIN