1497856751 NPI number — ERIC J FRYER MD

Table of content: ERIC J FRYER MD (NPI 1497856751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497856751 NPI number — ERIC J FRYER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRYER
Provider First Name:
ERIC
Provider Middle Name:
J
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:
1497856751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21008 NORTHERN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11361-3211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-224-8200
Provider Business Mailing Address Fax Number:
718-819-0244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21008 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11361-3211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-224-8200
Provider Business Practice Location Address Fax Number:
718-819-0244
Provider Enumeration Date:
09/26/2006

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: 207N00000X , with the licence number:  185911 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2299670 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2691300 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DS699 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: EF02K52220 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010553448 . This is a "THE GUARDIAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010185911NY02 . This is a "ANTHEM HEALTH OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4C0917 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 30804P . This is a "HIP OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 159125 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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