Healthcare Provider Details

I. General information

NPI: 1912528340
Provider Name (Legal Business Name): FRANCINE FRADELLA DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 N BROADWAY
MASSAPEQUA NY
11758-2395
US

IV. Provider business mailing address

747 N BROADWAY
MASSAPEQUA NY
11758-2395
US

V. Phone/Fax

Practice location:
  • Phone: 516-799-2771
  • Fax: 516-799-2982
Mailing address:
  • Phone: 516-799-2771
  • Fax: 516-799-2982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCINE FRADELLA
Title or Position: OWNER
Credential: DO
Phone: 516-799-2771