1962717546 NPI number — DR. PATRICK DOMENICO FRISELLA D.O.

Table of content: DR. PATRICK DOMENICO FRISELLA D.O. (NPI 1962717546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962717546 NPI number — DR. PATRICK DOMENICO FRISELLA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRISELLA
Provider First Name:
PATRICK
Provider Middle Name:
DOMENICO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRISELLA
Provider Other First Name:
PATRIZIO
Provider Other Middle Name:
DOMENICO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962717546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
672 DOGWOOD AVE
Provider Second Line Business Mailing Address:
#322
Provider Business Mailing Address City Name:
FRANKLIN SQUARE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11010-3247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-510-4328
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
672 DOGWOOD AVE
Provider Second Line Business Practice Location Address:
#322
Provider Business Practice Location Address City Name:
FRANKLIN SQUARE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11010-3247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-510-4328
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2010

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: 207Q00000X , with the licence number:  255862 , 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)





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