| Doctor Name: | GWEN MELISA FULO |
| NPI Number: | 1003904103 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 40QA00891900 |
| Business Practice Address: | 2033 Morris Ave Union, NJ - 070836013 |
| Business Phone Number: | 9086885641 |
| Business Fax Number: | 9086887038 |
| Mailing Address: | 21 Woodward Ln, BASKING RIDGE |
| State: | NJ |
| Postal Code: | 079202718 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 40QA00891900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |