Healthcare Provider Details

I. General information

NPI: 1891836458
Provider Name (Legal Business Name): NAOMI CHARLOTTE FRUMESS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13802 QUEENS BLVD
BRIARWOOD NY
11435-2642
US

IV. Provider business mailing address

751 BRIGGS HWY
ELLENVILLE NY
12428-5501
US

V. Phone/Fax

Practice location:
  • Phone: 718-657-1100
  • Fax: 718-657-1870
Mailing address:
  • Phone: 845-647-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF333151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: