Healthcare Provider Details

I. General information

NPI: 1568925089
Provider Name (Legal Business Name): DAVID FRUCHTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 05/05/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIRST AVENUE AT 16TH STREET
NEW YORK NY
10003-0000
US

IV. Provider business mailing address

350 E 17TH ST FL 20
NEW YORK NY
10003-3805
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-1808
  • Fax: 212-420-2025
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number316089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: