Healthcare Provider Details

I. General information

NPI: 1104248301
Provider Name (Legal Business Name): DESIREE FRANK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W 97TH ST
NEW YORK NY
10025-6450
US

IV. Provider business mailing address

860 E 37TH ST
BROOKLYN NY
11210-1937
US

V. Phone/Fax

Practice location:
  • Phone: 212-749-1820
  • Fax:
Mailing address:
  • Phone: 718-421-1131
  • Fax: 718-421-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337646
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number531835
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: