Healthcare Provider Details

I. General information

NPI: 1427259373
Provider Name (Legal Business Name): STEVEN M FRUCHTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 PARK AVE SUITE 1 FW
NEW YORK NY
10128-1244
US

IV. Provider business mailing address

1150 PARK AVE SUITE 1 FW
NEW YORK NY
10128-1244
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-7700
  • Fax: 212-996-8034
Mailing address:
  • Phone: 212-427-7700
  • Fax: 212-996-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number135990
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: