| Doctor Name: | DR. DAVID ANTHONY FULLAND |
| NPI Number: | 1023226370 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 000013 |
| Business Practice Address: | 300 West 135th Street Suite 6u Ny, NY - 10030 |
| Business Phone Number: | 9174689840 |
| Business Fax Number: | 2126903241 |
| Mailing Address: | 300 West 135th Street, Suite 6u NY |
| State: | NY |
| Postal Code: | 10030 |
| Phone Number: | 9174689840 |
| Fax Number: | 2126903241 |
| NPI Enumeration Date: | 05/18/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 000013 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |