Healthcare Provider Details

I. General information

NPI: 1124646773
Provider Name (Legal Business Name): GABRIELLE NICOLE FRUMUSA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/22/2023
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 LONG POND RD
ROCHESTER NY
14626-4122
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-7000
  • Fax:
Mailing address:
  • Phone: 585-723-7870
  • Fax: 585-723-7871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number25407
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number025407
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: