Healthcare Provider Details

I. General information

NPI: 1225620370
Provider Name (Legal Business Name): JANE FRUMBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 CLUB RD
WINDHAM NY
12496-1249
US

IV. Provider business mailing address

144 PINE SREET SUITE 140
KINGSTON NY
12401
US

V. Phone/Fax

Practice location:
  • Phone: 516-658-1309
  • Fax:
Mailing address:
  • Phone: 845-768-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111171-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: