Healthcare Provider Details

I. General information

NPI: 1528590403
Provider Name (Legal Business Name): RENEE FRUCHTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

3411 WAYNE AVE FL 2D
BRONX NY
10467-2535
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5000
  • Fax:
Mailing address:
  • Phone: 718-920-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number308383
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: