Provider Demographics
NPI:1972194405
Name:FULOP, MICHAEL LASZLO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LASZLO
Last Name:FULOP
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ANCHOR DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7820
Mailing Address - Country:US
Mailing Address - Phone:516-541-5187
Mailing Address - Fax:
Practice Address - Street 1:4 ANCHOR DR
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-7820
Practice Address - Country:US
Practice Address - Phone:516-541-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0466992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic