1144709064 NPI number — DOMINIQUE D FRASIER M.S.ED

Table of content: DOMINIQUE D FRASIER M.S.ED (NPI 1144709064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144709064 NPI number — DOMINIQUE D FRASIER M.S.ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRASIER
Provider First Name:
DOMINIQUE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.ED
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:
1144709064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5521 TOPSFIELD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13041-8679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-286-5960
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5962 ROUTE 31
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
CICERO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-698-0033
Provider Business Practice Location Address Fax Number:
315-698-0031
Provider Enumeration Date:
08/10/2018

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: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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