Provider Demographics
NPI:1902041536
Name:FULGINITI, JAMES D (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:FULGINITI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:603 N.BROAD STREET
Mailing Address - Street 2:CRAIG H.ROSEN, MD, P.A.
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096
Mailing Address - Country:US
Mailing Address - Phone:856-848-3500
Mailing Address - Fax:856-848-1008
Practice Address - Street 1:603 NORTH BROAD STEET
Practice Address - Street 2:CRAIG H. ROSEN, M.D.,P.A.
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096
Practice Address - Country:US
Practice Address - Phone:856-848-3500
Practice Address - Fax:856-848-1008
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MP00211200363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical