Healthcare Provider Details

I. General information

NPI: 1841223997
Provider Name (Legal Business Name): GAIL FRASER-FARMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 GRANNY RD
FARMINGVILLE NY
11738-2130
US

IV. Provider business mailing address

180 GRANNY RD
FARMINGVILLE NY
11738-2130
US

V. Phone/Fax

Practice location:
  • Phone: 631-698-3258
  • Fax: 631-698-3259
Mailing address:
  • Phone: 631-698-3258
  • Fax: 631-698-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number216533
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number216533
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: