Healthcare Provider Details

I. General information

NPI: 1457465510
Provider Name (Legal Business Name): FRAYA I KARSH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 E 64TH ST
NEW YORK NY
10065-7360
US

IV. Provider business mailing address

136 E 64TH ST
NEW YORK NY
10065-7360
US

V. Phone/Fax

Practice location:
  • Phone: 212-265-8854
  • Fax:
Mailing address:
  • Phone: 212-265-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22D101057600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number031756
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: