Healthcare Provider Details

I. General information

NPI: 1285758029
Provider Name (Legal Business Name): JASON MOSS FRITZHAND D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 BROADWAY FL 5
NEW YORK NY
10019-2002
US

IV. Provider business mailing address

10 CHARLOTTE ST
WHITE PLAINS NY
10606-3418
US

V. Phone/Fax

Practice location:
  • Phone: 212-757-1157
  • Fax: 212-757-7197
Mailing address:
  • Phone: 212-757-1157
  • Fax: 212-757-7197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number212969
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: