Healthcare Provider Details

I. General information

NPI: 1447306659
Provider Name (Legal Business Name): ANDREW FRUCHTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W 12TH ST
NEW YORK NY
10014-6025
US

IV. Provider business mailing address

9 GREGORY LN
MILLWOOD NY
10546-1039
US

V. Phone/Fax

Practice location:
  • Phone: 212-929-7527
  • Fax:
Mailing address:
  • Phone: 914-941-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number030472
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: