Provider Demographics
NPI:1134109382
Name:FULGENCIO-DELMONTE, JOSE A (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:FULGENCIO-DELMONTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320A ROOSEVELT AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7965
Mailing Address - Country:US
Mailing Address - Phone:718-404-9157
Mailing Address - Fax:718-424-0414
Practice Address - Street 1:9320A ROOSEVELT AVE FL 2
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7965
Practice Address - Country:US
Practice Address - Phone:718-404-9157
Practice Address - Fax:718-424-0414
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01664373Medicaid
G33248Medicare UPIN
NY01664373Medicaid