1982608592 NPI number — NEAL H FRAUWIRTH MD

Table of content: NEAL H FRAUWIRTH MD (NPI 1982608592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982608592 NPI number — NEAL H FRAUWIRTH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRAUWIRTH
Provider First Name:
NEAL
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982608592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
763 LARKFIELD RD FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11725-3131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-462-2225
Provider Business Mailing Address Fax Number:
631-670-2643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
763 LARKFIELD RD FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-462-2225
Provider Business Practice Location Address Fax Number:
631-670-2643
Provider Enumeration Date:
06/10/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  209422-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: 209422-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0000X , with the licence number: 42862 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 42862 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3000998 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4168373 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".