Healthcare Provider Details

I. General information

NPI: 1104743160
Provider Name (Legal Business Name): RYAN M. FREHILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S BROAD ST
PHILADELPHIA PA
19148-3542
US

IV. Provider business mailing address

65 CEDAR LAKE RD
BLAIRSTOWN NJ
07825-9650
US

V. Phone/Fax

Practice location:
  • Phone: 215-952-9000
  • Fax:
Mailing address:
  • Phone: 201-654-5042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NR21033000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: