1932271020 NPI number — JENNIFER FRYER MD

Table of content: JENNIFER FRYER MD (NPI 1932271020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932271020 NPI number — JENNIFER FRYER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRYER
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1932271020
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:
SUITE 2
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:
718-227-8200
Provider Business Mailing Address Fax Number:
718-819-0244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 BROADHOLLOW RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MELVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11747-4905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-673-5700
Provider Business Practice Location Address Fax Number:
631-673-0506
Provider Enumeration Date:
11/14/2006

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:  189419 , 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: 2H5052 . This is a "EMPIRE BC BS HUNTINGTON" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 116016 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2299669 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160682 . This is a "THE ELDER PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2539119 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2H5051 . This is a "EMPIRE BC BS BAYSIDE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2691261 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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