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General NPI Number Information
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NPI Number | 1083692230
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Entity Type | Organization
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Legal Business Name | FRADLIS MEDICAL CARE PC
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 2829 OCEAN PKWY
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City | BROOKLYN
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State | NY
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Zip | 11235-7858
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Country | US
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Telephone | 718-891-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 606 MICHELLE PL
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City | NORTH WOODMERE
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State | NY
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Zip | 11581-3041
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRSIDENT
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Name | IOSIF FRDALIS
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Credential | M.D.
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Telephone | 718-891-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 207428
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License Number State | NY
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