Healthcare Provider Details

I. General information

NPI: 1063879773
Provider Name (Legal Business Name): JUSTIN TYLER FRISENDA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 NORTH 39TH STREET MEDICAL OFFICE BUILDING, 1ST FLOOR, SUITE 120
PHILADELPHIA PA
19104-2640
US

IV. Provider business mailing address

51 NORTH 39TH STREET MEDICAL OFFICE BUILDING, 1ST FLOOR, SUITE 120
PHILADELPHIA PA
19104-2640
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-7320
  • Fax: 215-243-4605
Mailing address:
  • Phone: 215-662-7320
  • Fax: 215-243-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberOS025977
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: