Provider Demographics
NPI:1942447875
Name:VILMA G. FULE,M.D.,L.L.C.
Entity Type:Organization
Organization Name:VILMA G. FULE,M.D.,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FULE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-435-1660
Mailing Address - Street 1:2730 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5508
Mailing Address - Country:US
Mailing Address - Phone:201-435-1660
Mailing Address - Fax:201-435-8409
Practice Address - Street 1:2730 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5508
Practice Address - Country:US
Practice Address - Phone:201-435-1660
Practice Address - Fax:201-435-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04014800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1108301Medicaid
NJC55023Medicare UPIN