Healthcare Provider Details

I. General information

NPI: 1699862623
Provider Name (Legal Business Name): ELMAR H FRANGENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 WINTON RD S
ROCHESTER NY
14623-3057
US

IV. Provider business mailing address

3399 WINTON RD S
ROCHESTER NY
14623-3057
US

V. Phone/Fax

Practice location:
  • Phone: 585-334-6000
  • Fax: 585-334-2858
Mailing address:
  • Phone: 585-334-6000
  • Fax: 585-334-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1076821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: