Healthcare Provider Details

I. General information

NPI: 1407591126
Provider Name (Legal Business Name): MR. YITZCHOK MOSHE FRANK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 GRAND ST
NEW YORK NY
10002-4800
US

IV. Provider business mailing address

43 N MADISON AVE UNIT 101
SPRING VALLEY NY
10977-5871
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-1970
  • Fax:
Mailing address:
  • Phone: 347-633-6408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP114907
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: